SCHEDULE A BACKFLOW TEST

Please fill out the form below with the exact CID # and email you used to schedule your appointment with from last year. If your CID # and email match, it will pre-populate your data and will qualify you for auto-scheduling at the end of this form.

If you're a new customer or if you don't remember your CID and / or email please click the NEXT PAGE button.

Note We do not install the Backflow Device or turn the water on to the lawn sprinkler system. However, we do test, repair and replace defective / frozen Backflow Devices.

Hello "First Name"

We found that you have already scheduled this year, here are all your details. If something has changed or is incorrect, please call the office at 312-638-9878.

Thank you for your Business!

The Municipal Backflow Team

Here is a summary of all device fees and village fees associated with your test.

Your auto-scheduling form is almost complete. Once you click the create work order button at the bottom of this form, your work order will be created. Please check your email for further details.

Thank you for your Business!

The Municipal Backflow Team

The day before and the day of your appointment, you will be emailed a 3-hour time window of your technician's ETA, estimated time of arrival.

This is why confirming your email after scheduling is imperative, so you're up-to-date with your reminders and the emails don't end up in the spam folder.

Congratulations, we found your data in the database and you successfully qualified for auto-scheduling from the site.

Grayed out fields cannot be edited and qualify for auto-scheduling at the end of this form, we will contact you directly.

Your 10 minutes are up, please get new dates.

ROUTING / APPOINTMENT EXPLANATION

- There are many variables that must be considered to give our customers the best service at the most competitive price. We have factored all variables and have concluded that this is the best way to accomplish this.

- We send notices via mail and email 3 months early to begin routing each technician’s day. This is why it is so important to respond as soon as you receive our correspondence.

- The route is being built in real time and many changes occur during these 3 months. These changes will not effect your test date. This is why we ask for a generic time frame of 7am - 4pm, so there are as many options as possible in filling up the day.

- Due to the nature of change, we must avoid specific times in order to stay efficient. Customers reschedule frequently and if the route is now permanent, it is no longer flexible, therefore wasting fuel and time. Of course, we can accommodate special situations, but we ask you for the biggest time frame and understanding.

- The day before and the day of your appointment, you will be emailed a 3-hour time window of your technician's ETA, estimated time of arrival. This is why confirming your email after scheduling is imperative, so you're up-to-date with your reminders and the emails don't end up in the spam folder.

- The day of your appointment, your technician's day is set and cannot be altered. Please be considerate to all the other people before and after your appointment to help us keep the 3-hour window as small as possible.

Step 1 of 4

25%

The dates are valid for 10 minutes. We need this restriction to provide the optimal schedule.

You can request new date options in:

Sorry, we couldn't find your data in the database. Fill in the form below.
That email wasn't found in a system, please try to use different email and/or CID number if you have one.

Sorry, there are no suitable dates available. Submit a form below to send an email to us, we will call you back then.

Sorry, server is busy at the moment. Submit a form below to send an email to us, we will call you back then.

Sorry, you have too many devices to complete the form automatically. Submit a form below to send an email to us, we will call you back then.

We found your data in the database, but we do not have data on devices, so, unfortunately, we cannot offer you auto-scheduling. Please fill out the form and our managers will contact you

We found your data in the database, but your due date has expired. Unfortunately, we cannot offer you auto-scheduling at this time. Please fill out the form and our staff will contact you to determine if we are able to apply for an extension with your city.

Sorry we can't allow auto-scheduling to you because several of your devices have two may different due dates. Please call the office to schedule 312-638-9878. Thank you!

Your due date falls before the date that you provided. This could be from scheduling too late or not knowing when it was due. Please contact the office to determine if we can apply for an extension with your city.

Looks like you already have WO in progress, so we could not allow you create another one. If this is not the case, please fill out the form and we will contact you.

Sorry we could not allow you to auto-schedule due to your hours of operation. Please let us know in the additional comments below the best way to contact you to get your appointment scheduled.

IS THE BACKFLOW ASSEMBLY LOCATED AT A COMMERCIAL OR RESIDENTIAL PROPERTY?

Commercial

Residential

CID:

EMAIL:

CID # (CUSTOMER IDENTIFICATION NUMBER)

If you retrieved a correspondence letter from us, enter your CID# (Customer Identification Number) located at the top right corner.

CCN # OR SITE ID #

Often provided by your City or Village.

NAME:*

FIRST

LAST

EMAIL:*

If you can not provide a valid email address at this time, please call the office (312) 638-9878 to schedule.

PHONE:*

IS (068) 904-1882 YOUR MOBILE, HOME OR WORK NUMBER?*

MOBILE

HOME

WORK

OTHER

WILL TEST TEST BE THE SITE CONTACT FOR THE SCHEDULING / UPDATES?*

YES

SITE CONTACT NAME:*

FIRST

LAST

SITE CONTACT EMAIL* SITE CONTACT PHONE #*

CID # (CUSTOMER IDENTIFICATION NUMBER)

If you retrieved a correspondence letter from us, enter your CID# (Customer Identification Number) located at the top right corner.

CCN # OR SITE ID #

Often provided by your City or Village.

NAME:*

FIRST

LAST

EMAIL:*

If you can not provide a valid email address at this time, please call the office (312) 638-9878 to schedule.

PHONE:*

IS (068) 904-1882 YOUR MOBILE, HOME OR WORK NUMBER?*

MOBILE

HOME

WORK

OTHER

RESIDENTIAL SITE ADDRESS:*

STREET ADDRESS

ADDRESS LINE 2

CITY

STATE

ZIP CODE

IS THE MAILING AND BILLING ADDRESS THE SAME AS THE SITE ADDRESS ENTERED ABOVE?*

yes

BILLING /MAILING ATTENTION TO:*

ATTENTION: BOB SMITH: COMPANY OR BUSINESS NAME

BILLING /MAILING ADDRESS:*

STREET ADDRESS

ADDRESS LINE 2

CITY

STATE

ZIP CODE

WILL BE THE CONTACT FOR SCHEDULING / UPDATES?*

yes

SITE CONTACT NAME:*

FIRST

LAST

SITE CONTACT PHONE #* SITE CONTACT EMAIL*

COMPANY OR BUSINESS NAME:*

IS THE WORK AT TEST TO BE PERFORMED SUBJECT TO PREVAILING WAGE?*

yes

See FAQ link below for information on prevailing wage.

Prevailing Wage Act FAQ

SITE ADDRESS OF BACKFLOW ASSEMBLY / DEVICE(S) FOR TESTING:*

STREET ADDRESS

ADDRESS LINE 2

CITY

STATE

ZIP CODE

IS THE MAILING AND BILLING ADDRESS THE SAME AS THE SITE ADDRESS ENTERED ABOVE?*

yes

DO YOU USE A THIRD PARTY BILLING COMPANY?*

yes

PLEASE PROVIDE THE NAME OF THE BILLING COMPANY USED. *

Example: Vendor Cafe or Real Page

TEST OPENING TIME MONDAY - FRIDAY:*

TEST CLOSING TIME MONDAY - FRIDAY:*

OPERATIONAL HOURS:*

THE SITE ADDRESS IS: *

OWNER OCCUPIED

A RENTAL

VACANT

BILLING ATTENTION TO:*

ATTENTION: BOB SMITH: COMPANY OR BUSINESS NAME

STREET ADDRESS

ADDRESS LINE 2

CITY

STATE

ZIP CODE

MAILING ATTENTION TO:*

ATTENTION: BOB SMITH: COMPANY OR BUSINESS NAME

STREET ADDRESS

ADDRESS LINE 2

CITY

STATE

ZIP CODE

RENTAL TENANT NAME:*

FIRST

LAST

RENTAL TENANT PHONE:* RENTAL TENANT EMAIL*

This field is required in order for the tenant to receive scheduling updates.

HOW WILL THE TECHNICIAN GAIN ACCESS TO THE SITE / BACKFLOW DEVICES?*

SITE CONTACT

LOCKBOX ONSITE

Choose from saved site contacts or get a new one:

Other

The entered contact is already in the list.

SITE CONTACT NAME:*

FIRST

LAST

SITE CONTACT PHONE:* SITE CONTACT EMAIL*

This field is required in order for the site contact to receive scheduling updates.

DESCRIBE LOCATION OF LOCKBOX?* LOCKBOX CODE:*

THE SITE LOCATION YOU ENTERED IS IN CHICAGO. IS THIS DOWNTOWN, IN THE LOOP? *

yes

PLEASE PROVIDE ANY SPECIAL PARKING INSTRUCTIONS, SUCH AS, CAN THE TECHNICIAN PARK IN THE DOCK / PARKING VOUCHERS, ETC.... *

* Parking Fees May Apply

IS THIS FOR YOUR LAWN IRRIGATION / LAWN SPRINKLERS?*

YES

NOT SURE?

DEVICE LOCATION?*

INSIDE RESIDENCE

OUTSIDE RESIDENCE

NOT SURE?

PLEASE CHOOSE THE EARLIEST DATE THAT YOU OR YOUR IRRIGATION COMPANY WILL HAVE THE BACKFLOW DEVICE(S) INSTALLED AND WATER TURNED ON BY.*

IS THIS A GATED COMMUNITY?*

YES NO

PLEASE ADD GATE INSTRUCTIONS FOR THE TECHNICIAN BELOW.*

THE SITE ADDRESS IS: *

OWNER OCCUPIED

A RENTAL

VACANT

RENTAL TENANT NAME:*

FIRST

LAST

RENTAL TENANT PHONE:* RENTAL TENANT EMAIL*

This field is required in order for the tenant to receive scheduling updates.

HOW WILL THE TECHNICIAN GAIN ACCESS TO THE SITE / BACKFLOW DEVICES?*

SITE CONTACT

LOCKBOX ONSITE

Choose from saved site contacts or get a new one:

Other

The entered contact is already in the list.

SITE CONTACT NAME:*

FIRST

LAST

SITE CONTACT PHONE:* SITE CONTACT EMAIL*

This field is required in order for the site contact to receive scheduling updates.

DESCRIBE LOCATION OF LOCKBOX?* LOCKBOX CODE:*

IS THIS FOR YOUR LAWN IRRIGATION / LAWN SPRINKLERS?*

YES

NOT SURE?

DEVICE LOCATION?*

INSIDE RESIDENCE

OUTSIDE RESIDENCE

NOT SURE?

PLEASE CHOOSE THE EARLIEST DATE THAT YOU OR YOUR IRRIGATION COMPANY WILL HAVE THE BACKFLOW DEVICE(S) INSTALLED AND WATER TURNED ON BY.*

Fees:

Devices:

Loading ...

Additional details:

Select date:

Please choose as close to option one as possible to help us prevent price increases and maintain efficiency.

Sorry, there are no available WO dates for this selected date. Please choose another Irrigation date.

Date:

Fees:

Devices:

Loading ...

No need to call or email us. Please look for email. The day before and the day of your appointment, you will be emailed a 3-hour time window of your technician's ETA, estimated time of arrival.

This is why confirming your email after scheduling is imperative, so you're up-to-date with your reminders and the emails don't end up in the spam folder.

Terms and Conditions

Once you have booked an appointment with us, it means we have reserved time in our schedule exclusively for you! And we do everything possible to not miss it or be late.

If you forget and miss the appointment or if the area is not accessible, then a trip charge will be incurred to compensate for our expense.

To avoid these charges, please call us ASAP and absolutely no later than 4pm CST the day before. Emailing or calling us after 5pm CST the day before will forfeit the early bird rate and rescheduling charges will incur, since this time has been reserved for you and is now a loss.

I have provided a primary email address and am responsible for checking it.

I am responsible for my appointment, even though a complimentary email reminder with the ETA will be sent.

I am aware that there will be a trip charge if I miss my appointment.

The area will be clear and accessible the day of the appointment.

For outside irrigation devices, I am aware Municipal Backflow does not start up, winterize, or install the device and the device must be installed prior to our arrival with the water ON to the backflow device.

All dates are not suitable your comment

Thank you!

A representative from Municipal Backflow will contact you shortly.

THE SITE LOCATION YOU ENTERED IS IN CHICAGO. IS THIS DOWNTOWN, IN THE LOOP? *

yes

PLEASE PROVIDE ANY SPECIAL PARKING INSTRUCTIONS, SUCH AS, CAN THE TECHNICIAN PARK IN THE DOCK / PARKING VOUCHERS, ETC.... *

* Parking Fees May Apply

ADDITIONAL COMMENT(S) OR QUESTION(S):

SERVICE AREA

Municipal-Baclflow-Illinois-Service-Area

SCHEDULE A BACKFLOW TEST