Backflow Order Form
If you would like faster service and direct information on current stock and pricing please contact us at Contact us at (252)-354-3307 ( If you need larger sizes please contact the office)
What is the item you would like to order? *
Tax is included in the prices listed Charges will be billed to your account
Service address *
Your answer
Name *
Your answer
Phone number *
Your answer
Email *
Your answer
If you will not be picking up this yourself please list plumber that has permission to pick up your device
Your answer
Backflow Policies & Procedures Your electronic signature below indicates that you have read & understand the backflow policy in the link above. *
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