Finance Customer Billing Validation Form



Thank you for taking a few minutes to complete the Department of Finance Customer Billing Validation Form. The information completed below will be used to for all future billing and related correspondence with Fairfax County. Required fields are denoted with red asterisk * .

1. Enter the customer number and customer name as it appears on the original correspondence sent from Fairfax County Department of Finance 

* Customer Number:    (12 digit number located on first line of address block)

* Customer Name:  


* 2. Update Customer Name or Check Box

Updated Customer Name:  

No Update Necessary


 

3. Billing Address (enter full mailing address) 

* Address 1:   

Address 2:   

Suite/Room Number:   

* City:   

* State:

* Zip code:        + 4:    (optional)

 

4. Contact Information 

* Contact Name:   

* Telephone Number:  xxx-xxx-xxxx include area code 

E-mail Address:   

 

* 5. Please indicate which method Fairfax County should send any future invoices and related information. Only one option can be selected 

Via US Mail (to US postal address above)

Via Email (to email address listed below).  You will be sent an auto reply E-mail.

* E-mail Address: 

* Confirm E-mail Address: 

6. Comments: (limit 400 characters) 

    

 


Contact Fairfax County: Phone, Email or Twitter | Main Address: 12000 Government Center Parkway, Fairfax, VA 22035
Technical Questions: Web Administrator

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