Apex Backflow - Service Request

SERVICING ALL OF WAKE COUNTY AND SURROUNDING AREAS.

Local
Cross Connection
Control Programs
Apex
Cary
Durham
Holly Springs
OWASA
Orange Cty, Chapel Hill and surrounding areas.

CALL 919-414-8505 FOR SERVICE

Online Service Request
When you submit your service request report, it will be entered into our database for tracking purposes.

All information submitted is held in strict confidence. The information sent via this form is for
Apex Backflow use only and will not be distributed or shared with third parties.

Please be as specific as possible when describing your request and/or problem.

Step 1 Contact Information

Name:*		Service Category
Company:		Residential Commercial Industrial
Address:*
City:*		ST:* Zip:*

Email:

Phone:*	Main:	Best time to call:
	Work:	Morning Afternoon
	Cell:	Evening Anytime

Step 2 Type of Service

Select all that apply and please list any additional information that will help us provide you with the best service possible.

Backflow Inspection
	I have a notification from the water department for my annual inspection.	Yes No
	Please provide the due date on your notification.
	How many backflow devices are on site?

Rain Sensor

Lawn Sprinkler Service

Is your system currently operating Yes No
	System Check Up
	System Repair (please describe below)
	I'm a new homeowner and would like someone to give me a demo on how to run my system.



	Locate solenoid valve(s)

Install new sensor.
Service or replace existing sensor

Valve numbers to locate
(ie: 4, 8, 9)

Spring Startup 2009

Begins late March and early April.

Winterization 2008

Winterization begins the very end of October through the middle part of November just before temperatures dip down to the freezing mark.

If there is a particular problem or service request you are reporting, please describe it below.

Step 3 Desired Date

The calendars below are updated daily and show what dates are available.

Desired Date: mm/dd/yy

April 2009
S	M	T	W	T	F	S
			1	2	3	4
5	6	7	8	9	10	11
12	13	14	15	16	17	18
19	20	21	22	23	24	25
26	27	28	29	30

May 2009
S	M	T	W	T	F	S
					1	2
3	4	5	6	7	8	9
10	11	12	13	14	15	16
17	18	19	20	21	22	23
24	25	26	27	28	29	30
31

Step 4 Method of Payment

If you would like we can bill you and accept your payment online.

Method of Payment:		Check Cash
				We accept credit card payments through PayPal. You must have a valid email address. You DO NOT have to sign up for PayPal to use this payment option.

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Online Service Request When you submit your service request report, it will be entered into our database for tracking purposes.

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Online Service Request
When you submit your service request report, it will be entered into our database for tracking purposes.