| Check the box if you are a new customer | I am a new customer |
| Name | |
| E-mail | |
| Company Name | |
| Telephone | |
| Test Address | |
| Test City | |
| Test State | |
| Test Zip | |
| Billing Address (if different) | |
| Billing City | |
| Billing State | |
| Billing Zip | |
| Property Type | |
| Month Test is Due | |
| Water Purveyor (your water provider) (required) | |
PIN Number (if applicable) ⓘBeginning 02/01/2025, the City of Salem is now requiring testers to submit test results online, using a pin number their system will generate.
The pin number information is included in the notice of the annual backflow testing requirements that the city sends out the month testing is due. The pin # is eight digits and can include numbers or letters.
For more information regarding the new city requirements, please visit the city's website.
If you do not have the notice from the city, you can call or email to get the information. backflow@cityofsalem.net or 503-361-2212 | |
Location of Device on Property
(if new customer) | |
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| Additional Information/Comments (courtesy call, backyard, locked gate, dogs, etc) | |
What happens after your request is sent?Upon completion of your test, our technician will leave a packet on your front door which will include a copy of your test report along with our bill. If you would prefer your packet to be emailed to you, please note it in the comment section above. We will submit all necessary reports to your water provider. Please note, we will not contact you prior to testing unless you request a courtesy call. |
  
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