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Backflow Testing Request Form:


D & R Plumbing, Inc.
PO Box 385
Chino Hills, CA 91709


Please fill out the form below and one of our Representatives will contact you promptly.


 
Company Name:
Contact name:
Phone Number 1:
Phone Number 2:
Fax Number:
E-mail Address:



PLease specify what city, county or water company your backflow test forms are from:
Service Address:
City:
County:
Company:
Note: If the billing and service addresses are not the same please tell us in the "addtional information" box below.



How many backflow preventers do you need tested at this time?
When are your backflow tests due?
Do any of your backflow preventers supply a fire system?
Yes   No
Are any of your backflow preventers in a vandal cage or have padlocks?
Yes  No


Is there any addtional information or instructions you would like to tell us about?

      

D & R Plumbing, Inc. PO Box 385 Chino Hills, CA 91709 Contact Us