Backflow Prevention Information Request Form

All six (6) Sections of this Form must be completed by the Property Owner under Town of Aurora Bylaw 6213-19. If your property has multiple tenants with different business activities, please complete this form for each tenant

Section 1: Property Information

Property Name

Unit

City/ Town

Postal Code

Type of Building:

Industrial

Commercial

Plaza/Mall

Mixed Use

Institutional

Multi-Residential

Section 2: Property Owner Information

Owner Name

Contact Person:

Owner Address: Is the owner address the same as the property address?

Yes

No

Water Account No:

Tenant Information

See Tenant Information

Section 3: Tenant Information

Tenant Information

Not Applicable

Tenant Name

Tenant Contact Person:

Address Occupied by Tenant

Street

Unit

City/ Town

Postal Code

Phone Number

Mobile

Fax

Email Address

Water Account Number:

Section 4: Primary Contact for Backflow Prevention Program (BFPP)

Check if same as Property Owner

Same as Property Owner

Company Name

Company Contact Person:

Street

Unit

City/ Town

Postal Code

Phone Number

Mobile

Fax

Email Address