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Backflow Assembly Tester Certification Application

Step 1

Fill out the application form completely (official correspondence will be mailed to you at the address you provide on this page).

Step 2

New applicants must provide a notarized copy of his/her citizenship form, INCLUDING GOVERNMENT PICTURE I.D.


Initial CertificationRenewalReciprocity

Personal Information

Employment

Course Information

Would you like to be COMMERCIALLY AVAILABLE to test backflow prevention assemblies?

Yes

Continuing Education Units (CEUs)

Yes
Yes

Agree and Submit

I Agree