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City-Coordinated Backflow Prevention Assembly Testing Program Form - Commercial

Commercial Customer

Please provide the following information to participate in the City's Coordinated Backflow Assembly Testing Program. The City will coordinate the testing of your backflow assembly by a certified contractor.

An "*" marks a field as required.

Applicant Information








*










Please Complete Owner Information
















I understand that the Contractor, retained by the City to perform the testing of the backflow prevention assembly at the above noted location, is responsible for any damage to my property and that any questions or concerns regarding the testing services should be directed to the Contractor after the test is performed. I have read the information sheet here.


By checking this box, I acknowledge that I have read and agree to the terms of this form and the Talgov.com Privacy Policy. I understand that this electronic acknowledgement is legally binding and has the same effect as my handwritten signature. I also understand that the Contractor, retained by the City to perform the testing of the backflow prevention assembly at the above noted location, is responsible for any damage to my property and that any questions or concerns regarding the testing services should be directed to the Contractor after the test is performed. I have also read the information sheet here.
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