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2. Customer Release of Information Authorization Form

   House Bill H.B. 872 Confidentiality

   Pursuant to Section 182.052 of the Texas Utilities Code, except as provided by Section 182.054, the City of Manvel may not disclose personal information in a customer’s account record, or any information relating to the volume or units of utility usage or the amounts billed to or collected from the individual for utility usage unless the customer requests that the City of Manvel disclose the information. To elect disclosure of your personal information in your customer account record please complete and sign the form below.

4. Pursuant to Section 182.052 (c) (1) of the Utility Code

   By providing my information and marking the appropriate box below, I do hereby request to disclose or rescind my previous request for disclosure.

6. Name*
7. Phone Number*
9. Address *
11. City*
12. State*
13. Zip*
15. Check the Appropriate Box Below:*

    1. Request to SHARE my information pursuant to Section 182.052 (b).
    2. RESCIND a previous request for disclosure pursuant to Section 182.052 (d).

17. If you have any questions or concerns, please contact Utility Billing at 281-489-0630 (Ext. 2).

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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