Update Point of Contact Information

Water System Name

System ID #

If known

Current active number of connections on water system:

Numeric entry only

NWS would like to make sure that we have the correct & current contact information for the owner, primary and secondary point of contact for the Water System, to do this please submit the form below and please complete the entire form.

Water System OWNER Information:

OWNER Full Name

OWNER Title

OWNER Email

OWNER Home Phone

OWNER Work Phone

OWNER Cell Phone

OWNER Street Address

Water System PRIMARY CONTACT Information:

PRIMARY CONTACT Full Name

PRIMARY CONTACT Title

PRIMARY CONTACT Email

PRIMARY CONTACT Home Phone

PRIMARY CONTACT Work Phone

PRIMARY CONTACT Cell Phone

PRIMARY CONTACT Address

Water System SECONDARY CONTACT Information:

SECONDARY CONTACT Full Name

SECONDARY CONTACT Title

SECONDARY CONTACT Email

SECONDARY CONTACT Home Phone

SECONDARY CONTACT Work Phone

SECONDARY CONTACT Cell Phone

SECONDARY CONTACT Address

Water System BILLING CONTACT Information:

BILLING CONTACT Full Name

BILLING CONTACT Title

BILLING CONTACT Email

BILLING CONTACT Home Phone

BILLING CONTACT Work Phone

BILLING CONTACT Cell Phone

BILLING CONTACT Address

Party responsible for treatment system operation & maintenance (If your system has treatment)

Water System PRIMARY TREATMENT CONTACT Information:

PRIMARY TREATMENT CONTACT Full Name

PRIMARY TREATMENT CONTACT Title

PRIMARY TREATMENT CONTACT Email

PRIMARY TREATMENT CONTACT Home Phone

PRIMARY TREATMENT CONTACT Work Phone

PRIMARY TREATMENT CONTACT Cell Phone

Secondary party responsible for treatment system operation & maintenance (If your system has treatment)

Water System SECONDARY TREATMENT CONTACT Information:

SECONDARY TREATMENT CONTACT Full Name

SECONDARY TREATMENT CONTACT Title

SECONDARY TREATMENT CONTACT Email

SECONDARY TREATMENT CONTACT Home Phone

SECONDARY TREATMENT CONTACT Work Phone

SECONDARY TREATMENT CONTACT Cell Phone

Anything you think we should know?