When completing this form, ABC Backflow NW asks that you have a form of payment ready when the tester arrives, or you can pay beforehand.

We accept Cash, Check & Credit Cards (even Amex)

You can state in the Special Instructions box below, how you would like to pay, or if you would like a call before. (if paying beforehand, simply state "call for payment.")

DO NOT LEAVE ANY PAYMENT INFORMATION ON THIS SHEET

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