Charlotte Backflow | Backflow Preventer Test Request

Customer/Bill To Name

Subdivision

Property Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Is the service address the same as the billing address?

Billing Address

Phone Number

Format: (000) 000-0000.

E-mail

I would like my invoice

We e-mail all invoices be default unless you select the option above to receive them by regular USPS mail instead.

Please make sure to whitelist our email address to avoid missing the invoice due to spam filters.

We invoice AFTER work/test has been completed.

Type of Backflow Assembly(ies) Needing to be Tested

Type of Backflow_OLD

Service Number, Device ID or CCN listed on letter

City of Charlotte only (Service No), Concord (Device ID) or Kannapolis (CCN)

Device Location(s)

This is found under location of assembly.

Test Due Date

MonthDayYear

Optional: Upload a copy of your letter from the city

Upload a File

Does someone need to be on site/home to complete the test?

NOTICE:

IF YOU HAVE SELECTED RESIDENTIAL IRRIGATION AND THEN SELECTED THAT SOMEONE NEEDS TO BE HOME ABOVE, YOU *MUST* LIST IN THE COMMENTS WHEN SOMEONE CAN BE AVAILABLE AND/OR WHY SOMEONE NEEDS TO BE HOME. IF AN APPOINTMENT MUST BE MADE THEN THE STANDARD TEST RATE OF $90 WILL APPLY. WE TYPICALLY DO IRRIGATION DEVICES WHEN WE ARE IN THE AREA WHICH IS WHY A DISCOUNT IS OFFERED.

Comments

If you desire a copy of the completed test report for your records, PLEASE note that in the comments field. 0/200

How did you hear about/find us?

How would you like to receive your invoice?

I agree that by submitting this service that I will pay all applicable service/materials charges as invoiced and that any verbal authorizations/approvals of work are hereby binding. I consent that if any repair parts are installed in/on my backflow device to achieve a passing result that I will pay reasonable materials and labor costs associated with such repair at tester's discretion, we typically will make repairs at time of test if we have parts on the truck and it will result in less labor costs to the customer to repair at time of test. I also agree to pay per the terms listed on the final invoice and a 1.5% monthly interest (18% per annum, $5 monthly min.) charge on overdue balances and all collection costs incurred. I understand that my passing backflow test report may be held pending final payment. I understand that the results as presented reflect the state of the device AT THE TIME the test was performed, we cannot be held liable for anything that occurs before or after the test was performed up to and including water contamination or property damage.

I understand that my irrigation system backflow will be left the way it was found (Example: if your device is winterized when we arrive, we will put it back the way it was found, we WILL NOT leave the water on) unless I ask otherwise. I also understand that if the water is not on to my backflow preventer that additional charges may apply to turn the water on/off. A backflow test is not a substitution to a Spring Startup service to get the water turned on for the season.