Request for Disclosure of Information

Please complete this form if you would like the Corinth Utility Billing department to disclose personal and utility usage information.

Please Note:

The federal Red Flag Rule was passed on November 1, 2008. The law states that customer service is only allowed to speak with people listed on the account and only after verifying personal information. Texas House Bill 872 states that a government-operated utility may not disclose personal and utility usage information for government-operated utility customers unless the customer requests that the government-operated utility disclose such information on an appropriately marked form or other written request for disclosure.

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Last Name *

First Name *

Cell Phone *

Service Address *

Drivers License Number *

Date Of Birth

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Email address *

Disclosure Authorization

By submitting this form, I understand that I am hereby authorizing the City of Corinth Utility Billing Department to disclose personal and utility usage information.

Receive an email copy of this form *

Receive an email copy of this form.