Hydrant Flow Test Permit Request Form Page 2

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HYDRANT FLOW TEST FEE(as of February 1, 2013)
Initial Test………………………………………………………………………………………..$300.00
Each additional test(s) concurrent with above test ___________X $90 ……………………..$_______
Total monies due PRIOR to performing test…………………………………………………..$_______
Copy only of recent flow test (performed less than one (1) year prior, if available)
# of copies __________of test x $85 = $____________________
PAYMENT PRIOR TO WORK: All fees shall be paid prior to performance of the applicable work.
COMPUTATION: Fees are computed on the basis of prevailing costs incurred by M.A.W.C. and taking into
account wages paid, fringe benefits, overhead and other costs that may accrue. M.A.W.C. shall issue
regulations listing such charges and shall update them as necessary.
EFFECTIVE DATE: All standard charges shall become effective on the date they are filed with M.A.W.C.
YOU CAN NOW PAY FOR YOUR FLOW TEST WITH YOUR CREDIT CARD (VISA OR
MASTERCARD). PLEASE ENTER THE BELOW INFORMATION AND FAX (724-755-5922) OR
EMAIL THE FORM () TO HAVE YOUR TEST SCHEDULED PROMPTLY.
TYPE OF CARD(Circle One):
VISA
MASTERCARD
Card Holder Name: ______________________________________________________
Card Number: _________________________________Exp: _____/_____ MM/YY
Card Billing Address: ______________________________________Zip: __________ CVD:________
TO PAY BY CHECK MAKE CHECK PAYABLE TO: Municipal Authority of Westmoreland County or
M.A.W.C. and mail to: M.A.W.C.- P.O. Box 730 Greensburg PA 15601 ATTN: MARK YACKOVICH
OFFICE USE ONLY
Payment Received Date:___________________Check Number:_____________ Amount: ______________
_____________________________________________
___________________________________
Received by: (Signature)
Date

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