You are here:HomeAboutFormsPlumber's Application for inclusion in Council's Qualified Backflow Service Providers register & Website Listing
Plumber's Application for inclusion in Council's Qualified Backflow Service Providers register & Website Listing Business Name* - required ABN* - required Business Street Address* - required Contact Number* - required Business Email Address* - required Please select* - required Select We are currently listed in Council's register and wish to remain with any updated details We would like to be added to Council's register and be included the website listing We would like to be added to Council's register but NOT included in the website listing Do you consent to Tamworth Regional Council updating their records with the information provided above?* - required Select Yes No Backflow Accreditation Name of Staff Holding Backflow Accreditation* - required Accreditation Date* - required Attach Certificate* - required Statement of Attainment Please attach a copy of your Statement of Attainment/s in “Commission and Maintain Backflow Prevention Devices” (CPCPWT4012A or 22A). Statement of Attainment/s* - required Privacy Statement Privacy StatementPersonal information supplied to or collected by Tamworth Regional Council will only be stored and processed by Council for lawful purposes directly related to the functions and activities of Council. Any personal information supplied will only be disclosed to a third party for the purpose of performing a lawful function or activity and for no other purpose. Disclosure of personal information to a third party will be in accordance with Tamworth Regional Council's Privacy Management Plan (PDF 331.7KB). Mandatory field(s) marked with *