Hansen, KentBackflow Tester Registration
Date *
Te ste r Name *
Name of Company *
Addre ss *
Office Phone
Numbe r *
M obile Phone
Numbe r
Email Addre ss *
Inv oice Numbe r *
Registration is good for one year from the date of registration.
Once your information has been entered into our system, you will receive an email with your Invoice number. You will
need this Invoice number to pay for your registration on line at:
https://e ne rgovprodweb.coppelltx.gov/Ene rGov_Prod/Se l fSe rvi ce #/home
Cit y of Cop pell P ub lic W orks Dep t .
816 S. Co pp ell Rd ., S uite 103
Co pp ell, TX 75019
972-462-5150
9/18/2018
Kent Hansen
Air Performance Service
City
Dallas
State / Province / Region
TX
Postal / Zip Code
75238
Country
USA
Street Address
10510 Markison Rd
Address Line 2
9723873334
2146414964
rgaribay@airperformance.com
INV-00011909
• 111 • 1 •
v. �,���� ` '�"� �'�'.� �,_ �� ��,
• i • " '
BILLING CONTACT
Kent Hansen
Air Performance �• •��
10510 Markinson Rd •
Dallas, Tx 75238 �
INVOICE NUMBER INVOICE DATE INVOICE DUE DATE INVOICE STATUS INVOICE DESCRIPTION
INV-00011909 09/18/2018 09/18/2018 Paid In Full NONE
REFERENCE NUMBER FEE NAME TOTAL
Misc Fee Backflow Contractor Registration $75.00
SUB TOTAL $75.00
REMITTANCE INFORMATION TOTAL $75.00
City Of Coppell
P.O. Box 9478
Coppell,TX 75019
September 24,2018 255 Parkway Boulevard,Coppell Texas 75019 Page 1 of 1