Form Center Module

Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

▼Customer Forms

  1. Business Directory Information Form

    This is a form where a business can add/modify/delete information to be contained in the Town of Purcellville's Online Business... More…

  2. Contact Form
  3. Payment Plan for Delinquent Utility Bill

    This is a form to request a payment plan for a delinquent utility bill.

  4. Police Department Contact Form
  5. TOWN OF PURCELLVILLE

    Application for Employment

  1. Citizen Issue Form

    This form allows you to submit issues with utilities, streets, streetlights, tall grass, trash/recycling, or other community issues.

  2. FOIA Request Form

    This is a form for citizens to submit a request for public records subject to the Freedom of Information Act.

  3. Personal Property Bill Dispute Request

    This is a form to dispute a bill.

  4. Public Comments on Proposed Budget

    This is a form where you can provide comments to the Town Council on the Proposed Budget.

▼PPD Forms

  1. Compliment Form

    This form is for filing a compliment regarding an officer’s or other employee's, conduct or the level of service, provided by the... More…

  2. Report Aggressive Driving Form

    This form is only for reporting aggressive driving incidents, which took place within the Town of Purcellville.

  3. Service Complaint Form

    This form is for filing a complaint against an officer or other staff member of the Purcellville Police Department.

  1. Funeral Escort Request

    The Purcellville Police Department requires 48-hours advanced notice for any funeral escort. Once your online form is submitted, you... More…

  2. Serialized Inventory
  3. Traffic Complaint Form

    This form is in place to allow community members the opportunity to alert the Purcellville Police Department to potential traffic... More…