Reeves, William M.Backflow 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
9/20/2018
William M. Reeves
DSS FireGuard, Inc
City
Garland
State / Province / Region
TX
Postal / Zip Code
75041
Country
USA
Street Address
2602 National Place
Address Line 2
2143417100
2143560223
mreeves@fireguard.com
INV-00011947
City of Coppell, TX
Public Works
255 Parkway Blvd, Coppell, TX 75019
Coppell, TX 75019
972-304-3500
Welcome
001553-0001 Debbie T. 09/20/2018 1i: 02AM
ENERGOV INVOICE
Reeves, William (DSS Fireguard)
2018 Item: INV-00011947
Balance due: 0. 00
Balance unpaid: 0 . 00
Backflow Contractor
Registration 75 . 00
Payment Id: 8920
--------------
75.00
Subtotal 75.00
Total 75.00
CREDIT CARD - UTILITY OPS 75 . 00
Visd ************4427
Ref=2074484701
Auth=04331G
20180920E557
AID=FC2DA6B2F354F50E3030
Invoice=78200620180920110140
AuthCode=04331G
Entry=Chip Read
AppLabel=VISA CREDIT
ATC=0025
Seq=78200620180920110140
Change due 0.00
Paid by: Reeves, William (DSS Fireguard)
Signature:
Thank you for your payment
CUSTOMER COPY