Residential Backflow Testing Agreement ONLINE Form

I certify the information I have provided below is true and correct. I authorize SUB Water Division to provide my contact information to the program contracted tester. I grant SUB Water Division permission to schedule and authorize a certified backflow tester to enter the property listed above to test the backflow prevention assembly, to assure program requirements have been met.

By signing this agreement, I choose to voluntarily enter into this SUB Water Division backflow assembly testing program, which I understand will include a $29.00 testing fee (per assembly) to be added to my water bill upon completion of an assembly test. I also understand that any backflow assembly repair or replacement are separate costs and are not included in the testing fee.

Residential Backflow Testing Agreement Online Form

Customer Name(Required)
Customer Information(Required)
Service Address(Required)
Mailing Address (if different than Service Address)
MM slash DD slash YYYY
Signature (type your name)(Required)

By signing and hitting submit, I understand the terms of this agreement will continue until I contact SUB Water Division to remove myself from the program or I move. SUB Water Division has the right to remove me from the testing program at their discretion.