JOHN DAVIS City of Coppell, TX
Public Works
255 Parkway Blvd, Coppell, TX 75019
Coppell, TX 75019
972-304-3500
Welcome
002546-0001 Debbie T. 03/04/2019 10: 59AM
ENERGOV INVOICE
Davis, John (North Texas Backflow)
2019 Item: INV-19-00015609
Balance due: 0. 00
Balance unpaid: 0. 00
Backflow Contractor
Registration 75. 00
Payment Id: 13190
75. 00
Subtotal 75. 00
Total 75.00
CREDIT CARD - UTILITY OPS 75 . 00
Visa ************2870
Ref=3240087701
Auth=115789
20190304EBA6
AID=A0000000031010
Invoice=78200620190304105843
AuthCode=115789
Entry=Chip Read
AppLabel=VISA DEBIT
ATC=0523
Seq=78200620190304105843
--------------
Change due 0. 00
Paid by: Davis, John (North Texas
Backflow)
Signature:
Thank you for your payment
CUSTOMER COPY
T H E • C ( T Y • O F
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City of Coppell Public Works Dept.
816 S. Coppell Road
Coppell, TX 75019
972-462-5150
www.coppel Itx.gov
BACKFLOW REGISTRATION FORM
Registration is for one year from the date of registration or re-registration.
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Name: ������� � .� �l
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Mailing Address: ��� � �, • "� lJ � (.
(Street& umber/PO Box, City, State and Zip)
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Physical Address: ��,�� �`'�. �6 �� �'(�'���°�^'�1/1 � �s`rG� �
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Office Phone Number: ���;�J�— L"�,7`�
Mobile Phone Number: —si-7'�ti�
E-mail Address: 'C�� CC- • /�e
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