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Council Forms

  1. Community Policing Advisory Committee Contact Form

    Contact form for the Community Policing Advisory Committee (CPAC)

  2. Council Request Form
  3. New Town Council Member Information Worksheet
  4. Request to Speak Form

    Please complete this form if you would like to speak at the next Town Council Meeting during the Citizen/Business Comments portion of... More…

  1. Council Contact Form
  2. Economic Development Advisory Committee Contact Form

    Contact form for the Economic Development Advisory Committee (EDAC)

  3. Planning Commission Contact Form

    Contact form for the Planning Commission

  4. Ribbon Cutting Request Form

    Thank you for your interest in hosting a Ribbon Cutting in Purcellville. Please complete and submit the form at least 2 weeks prior to... More…

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. FOIA Request Form

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

  4. Personal Property Bill Dispute Request

    This is a form to dispute a bill.

  5. Public Comments on Proposed Budget

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

  1. Citizen Issue//Concern Form

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


    The repayment plan allows utility customers additional time to pay their balance as a result of financial hardship from the COVID-19... More…

  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. Train Station Rental Application

Parks and Rec Forms

  1. 2023 Christmas in Purcellville Parade Entry Form

    The annual Christmas in Purcellville Parade will be held on Saturday, December 9th starting at noon. The route is about 2.5 miles long... More…

  2. Test Form


  1. Application for Special Event Permit
  2. Volunteer Hour Tracking

    This form is to help the volunteers who serve on committees, commissions, and boards related to Parks and Recreation track the number... More…

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. Funeral Escort Request

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

  3. Report Aggressive Driving Form

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

  4. Serialized Inventory
  5. Traffic Complaint Form

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

  1. Crime Prevention Survey Request

    This form is for requesting a Crime Prevention Survey by a CPTED certified officer, provided by the Purcellville Police Department.... More…

  2. House Check Request Form
  3. Request a Car Seat Safety Check

    We all want our children to travel safely in while in transit. Installing a car seat for younger children and babies can be a... More…

  4. Service Complaint Form

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

  5. VIPS Application

    Application for volunteer position with the Purcellville Police Department.

Purcellville Arts Council

  1. 2023 Celebrating the History of the Purcellville Train Station Art Contest

    Here is an opportunity for students to show their artistic talents in the contest called Celebrating the History of the Purcellville... More…

  1. 2023 Purcellville Train Station Logo Contest

    The Train Station Advisory Board and the Purcellville Arts Council are jointly hosting a logo contest for the Purcellville Train... More…