Date Requested Start Date of Water Service Applicant First Name Applicant Last Name Applicant State Issued ID Number Issuing State of ID Co Applicant? YesNo
    Co-Applicant First Name Co-Applicant Last Name Co-Applicant State Issued ID Number Issuing State of ID
    Mailing Address City State Zip Code Email Address Phone Number Alternate Phone Number Water Service Address Same as Mailing Address? YesNo
    Water Service Address City State Zip Code
    Current Status of Water Service OnOffNo ServiceNot Sure Non-typical water uses at the service address (check all that apply) Hot tubIn Ground Sprinkler SystemPoolFish Pond Additional Water Sources at the service (check all that apply) NoneWellSpringCreek/Stream Is the Applicant the owner of the property for which service is being requested? YesNo
    Owner’s First Name Owner’s Last Name Owner’s Phone Number Owner’s Address City State Zip Code

    Service dates cannot be guaranteed. Please allow two (2) working days for processing this application.
    Each service is unique and may require additional scheduling and/or construction fees.
    Please include a copy or scan of the applicant’s state issued identification (License or Identification Card)
    *A $30 activation fee will be added to the first billing.
    *If you sign up for Auto Pay at the time of your application, a $5 credit will be applied to your new account.

    We're here to help!

    Contact our office at (503) 554-8333, Monday- Friday from 9AM – 4PM (except holidays) or email us anytime at hilandinfo@nwnaturalwaterservices.com

    • Mailing Address:
      700 N College St
      Newberg, OR 97132
      PO Box 699
    • Phone:
      (503) 554-8333
      Toll-Free (855) 554-8333
    • Fax:
      (503) 554-9215
    • Monday - Friday:
      9:00 AM - 4:00 PM