Form Center

Search Forms:

Search Forms Select a Category

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Backflow Inspection Report Submission

Tester Information
First & Last Name*
Company Name*
Phone Number*
Email
Backflow Location Information
Business Name*
Address*
Physical Address Only
Number of Submissions
Type a number 1 - 5
Instructions
If a business has more than one backflow you may submit up to 5 at a time. If there are multiple businesses, please submit separately.
File Upload*
PDF Format is Preferred
File 2 Upload
File 3 Upload
File 4 Upload
File 5 Upload
Need a backflow form?
<style> .css { text-align: justify; } a.css { font-weight: bold; } </style> <div class = "css">Feel free to use <a href = "/DocumentCenter/View/274/Backflow-Inspection-Application-PDF" class = "css" target = "_blank">this</a hfref> one. Electronic signatures are accepted. Click <a href= "https://helpx.adobe.com/acrobat/how-to/fill-and-sign-forms-anywhere.html?set=acrobat--fundamentals--pdf-forms" class = "css" target = "_blank">here</a href> for more information about e-signing pdf documents.</div>

Feel free to use this one. Electronic signatures are accepted. Click here for more information about e-signing pdf documents.

Leave This Blank:

Submit