Bore water testing enquiry form

First name *

Last name *

Organisation

Phone number *

Email address for results *

Well permit number

Address where bore is located *

Address where sample bottles are to be sent (if different to above)

Number of sample points *

Have you used our testing services before *

• Yes
• No

Customer to collect water samples

• Customer will collect sample bottles from AWQC
• Sample bottles to be sent to customer via courier

Samples to be collected by AWQC field services *

• No
• Yes^