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EMAIL AUTHORIZATION FOR BACKFLOW NOTICES

By signing and submitting the following email address, I hereby accept full responsibility for all notices of tests due or fine assessements will be sent by email to me. No notifications will be sent via regular mail.

Email:
Confirmation of Email:
I certify that the email submitted above is valid
Name:
Phone:
All Addresses listed here, please
email to the above email address

This may be cancelled at any time by filling out and submitting the CANCELLATION OF EMAIL NOTIFICATION FORM on this web site.

If at any time your email address is returned as invalid, the request will be cancelled and all future notices will be mailed until a new email authorization with new email address is submitted.
     
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