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2. Request for Disclosure

   In accordance with Chapter 182 of the Texas Utilities Code, I request the disclosure of the following personal information (name, address, volume or units of your utility usage, amounts billed to or collected from you for the utility usage and service periods.)

   1. I Request DISLOSURE
4. Request for CONFIDENTIALITY

   I previously requested disclosure of personal information from my utility account and am now requesting that the account be updated as confidential.

   1. I request CONFIDENTIALITY
6. First Name on Account*
7. Last Name on Account*
9. Account Number*
11. Service Address*
13. Email Address*
15. Phone Number*
17. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
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19. 1. Receive an email copy of this form.
20. Email address

    This field is not part of the form submission.

21. Submit

* indicates a required field