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SCHEDULE YOUR BACKFLOW TEST BY FILLING OUT THE FORM BELOW

If your backflow assembly is located indoors, or is in an area that cannot be accessed, we will attempt to contact you for further scheduling details. Once your test is scheduled, you will receive a booking notification with the approximate date and time the test will be completed. Our goal is to complete tests within 1 week from the completion of this scheduling form to ensure it meets your testing due date.

Please Note: SOME WATER PURVEYORS IMPOSE AN ONLINE SUBMISSION FEE PER TEST REPORT. IF THIS IS THE CASE, YOU WILL SEE AN ADDITONAL CHARGE ON YOUR INVOICE LABELED, WATER PURVEYOR SUBMISSION FEE.

Schedule Test

Contact Information

Please fill out the information below. All fields marked with an * are required.

Name

Company Name

Phone

Service Address

Street Address

City

State

Zip Code

Water Purveyor/Company

Is this a residential or commercial address?

Is the billing address the same as the service address?

Billing Address

Street Address

City

State

Zip Code

Backflow Assembly Information

NOTE: If we have tested at this location in the past, we do not need all the assembly information. If we have not, you can find this information on the notice and/or test report (if you have them) that was sent to you by your water provider or company.

Number of Assemblies

Assembly Make

Assembly Model

Assembly Serial #

Assembly Size

Test Due Date

Tester Access Code

Hazard ID

Assembly ID

Assembly location (if known)

Location Indoors or Outdoors?

Can the backflow assembly be easily accessed?

Additional Information

Discount Code

Additional Notes

Acknowledgement

There is no further action required on your part. Once we receive your form submission, we will promptly schedule your test into our route. No appointment is necessary for assemblies that are outside and accessible, and you do not need to be present.

I understand

This booking is for customers inside of our service area, which is roughly a 12-mile radius from downtown Puyallup (see map below).

I understand