Werback, Norman WBackflow 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
10/1/2018
Norman W Werback
wetdog Irrigation
City
Corinth
State / Province / Region
TX
Postal / Zip Code
76208
Country
USA
Street Address
3302 Benbrook
Address Line 2
9403958888
werback2043@yahoo.com
INV-00012125
City of Coppell, TX
Public Works
255 Parkway Blvd, Coppell, TX 75019
Coppell, TX 75019
972-304-3500
Welcome
001622-0001 Debbie T. 10/O1/2018 11: 35AM
ENERGOV INVOICE
Werback, Norman (Wet Dog Irrigation )
2018 Item: INV-00012125
Balance due: 0. 00
Balance unpaid: 0 . 00
Backflow Contractor
Registration 75 . 00
Payment Id: 9191
--------------
75. 00
Subtotal 75.00
Total 75.00
CREDI'P CARD - UTILITY OPS 75 . 00
American Express ************1002
Ref=2135308101
Auth=811959
201810010E29
AID=A000000025010801
Invoice=78200620181001113507
AuthCode=811959
Entry=Chip Read
AppLabel=AMERICAN EXPRESS
ATC=000D
Seq=78200620181001113507
Change due 0.00
Paid by: Werback, Norman (Wet Dog
Irrigation )
Signature:
Thank you for your payment
CUSTOMER COPY
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