Book Your Test Sample – Provo Water Company

Name *

First

Last

PWC Account Number (add 0 if none) *

Phone *

Email *

Collection Location *

Address Line 1

Address Line 2

City

State / Province / Region

This is the location where you will be taking the water sample.

Which Test Do You Require?

Weather Conditions: Rain

Weather Conditions: Wind

Sample Type

Sample Delivery

Date & Time of Sample Collection *

Date

Time

Terms and Conditions

By submitting this request, you agree to the following:-

Please tick ALL BOXES. *

I acknowledge that the applicable service fee will be charged to my account.
I acknowledge an invoice will be generated on submission of this form.
I understand turnaround is 5 business days.
I understand that all fees are non-refundable once dispatched.
I understand that service timelines may vary due to operational demands.
I acknowledge that PWCo may decline service if safety or access issues exist.

Signature *

Clear Signature

I confirm that I have read and understood the Terms & Conditions outlined above. I agree to provide accurate information and comply with all requirements for requested service.

Date / Time *

Date

Time

Monday	9:00 AM — 4:00 PM
Tuesday	9:00 AM — 4:00 PM
Wednesday	9:00 AM — 4:00 PM
Thursday	9:00 AM — 4:00 PM
Friday	9:00 AM — 4:00 PM
Saturday	Closed
Sunday	Closed