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Third Party Notification Form

  1. Please insert today's date
  2. You can find the account number on the upper right hand corner of your monthly billing statement. Please provide the full account number including the dash.
  3. Address, City, State, Zip
  4. Third Party Information:
  5. Address, City, State, Zip
  6. I authorize the Third Party to obtain a copy of my Water statement. I do understand that my account is confidential and this information can be given to the above noted Third Party. Ordinance No. 28: Identity Theft Prevention Program.
  7. Leave This Blank: