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2. We are pleased to offer online enrollment for the PID backflow maintenance program. Enrollment is not required but is an elected service created to benefit our customers. Customer may choose to maintain their own backflow device according to PID policies on backflow prevention.

4. Tell us about your current backflow prevention device:*
   -- Select One --I've already paid for a backflow device from PIDI haven't ordered a device yet but I'd like PID to install my FEMA-paid device during the meter projectI need water service now, please contact me using my contact information below.
6. Full Name*

   The PID water bill must be in your name.

8. Service Address*

   You must live at the address where the discount will be received.

10. PID Account Number*

    Example: "14-07845-01" - You can find your PID account number on your water bill.

12. Phone Number*

    Please enter a daytime phone number.

14. Email Address*
15. Re-Enter Your Email Address*
17. I attest I am the property owner or authorized agent.*

    1. I understand
19. I understand this decision is permanent for the life of the device and I (property owner) will be responsible for the annual maintenance fee for the backflow prevention device.*

    1. I understand
21. I understand this annual maintenance fee is based on PID's cost to administer the program and may be adjusted in the future.*

    1. I understand
23. I understand the PID Board of Directors reserves the right to make changes to the program or backflow policy at any time.*

    1. I understand
25. Electronic Signature (Type Your First and Last Name)*

    By submitting your electronic signature, you attest the information provided is true and correct, you understand the terms of the application, and will notify PID if you no longer qualify under the set terms.

27. Enter Today's Date*
    Enter Today's Date
Leave This Blank:


29. 1. Receive an email copy of this form.
30. Email address

    This field is not part of the form submission.

31. Submit

* indicates a required field