Tester Registration
Asterisks (
*
) indicate required fields
If you are an
existing tester
, do not fill out this form.
If you forgot your password,
click here
to reset your password.
Date
Backflow Tester Information
Last Name
*
First Name
*
Business Name
*
Address
*
City
*
State
*
Zip
*
Contact Phone
*
Email
(This will be your login username)
*
Include your contact information in the Backflow Tester Public List
*
Yes
No
Public Phone
Public Email
Tester Certification / Calibration
AWWA/ABPA Certificate Number
*
Certifying Agency
*
AWWA/ABPA Expiration Date
*
AWWA/ABPA Certificate Upload
*
Backflow Test Kit Certification Number
*
Calibrated By
*
Backflow Test Kit Calibration Date
*
Backflow Test Kit Expiration Date
Field Test Kit Calibration
*
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Asterisks (*) indicate required fields
Asterisks (*) indicate required fields