Ancelmo_JesusBackflow 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
9/26/2018
Jesus Ancelmo
Total Fire & Safety
City
Dallas
State / Province / Region
TX
Postal / Zip Code
75217
Country
USA
Street Address
429 Glenview St.
Address Line 2
2143816116
2149857737
jesusancelmo@ymail.com
INV-00012054
City of Coppell, TX
Public Works
255 Parkway Blvd, Coppell, TX 75019
Coppell, TX 75019
972-304-3500
Welcome
001590-0001 Debbie T. 09/26/2018 12: 52PM
ENERGOV INVOICE
Ancelmo, Jesus (Total Fire & Saiety, Inc. )
2018 Item: INV-00012054
Balance due: 0. 00
Balance unpaid: 0 . 00
Backflow Contractor
Registration 75 . 00
Payment Id: 9071
75. 00
Subtotal 75.00
Total 75.00
CREDIT CARD - UTILITY OPS 75 . 00
MaSterCard ************9339
Ref=2106219301
Auth=020265
201809268A11
AID=9BA6DA36F7F54FB70012
Invoice=78200620180926125228
AuthCode=020265
Entry=Chip Read
AppLabel=MASTERCARD
ATC=004D
Seq=78200620180926125228
-------------
Change due 0. 00
Paid by: Ancelmo, Jesus (Total Fire &
Safety)
Signature:
Thank you for your payment
City of Coppell, TX COPY