Silsbee, TX · Hardin County
Utility Disclosure Form
Silsbee utility customers use this form to authorize disclosure of personal account information or usage, services, and billing information to a named recipient.
What this form is
This form lets a customer ask the City Utilities Department to disclose personal account information or information about utility usage, services, and billing to a named recipient. It also lets the customer authorize release of account information to the public upon written request and explains that the request may be rescinded by written notice.
Who needs it
A City utility customer who wants to authorize disclosure of account information to a named person or the public can use this form.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document has no notary block and identifies no notarized or sworn attachment; the customer completes the authorization without a notary.
How to submit this form
- 1
Download the Form
Download the Utility Disclosure Form.
- 2
Complete the Authorization
Enter the customer name and account number, select the information to disclose, and provide the recipient's name, address, and driver's license number.
- 3
Review the Release Options
Choose whether to authorize disclosure to a named recipient or public release upon written request.
- 4
Submit to the City
Return the form to the City Utilities Department; check the city website for current contact details.
Frequently asked questions
- What does the Silsbee Utility Disclosure Form authorize?
- It lets a utility customer authorize disclosure of personal account information or usage, services, and billing information to a named person. It also offers an option to authorize public release upon written request.
- Who can use this form?
- The form is for a customer of a government-operated utility who wants to request disclosure of account information. It asks for the customer name and account number, along with recipient details.
- Do I need a notary for the Utility Disclosure Form?
- No. The form has no notary block and identifies no notarized or sworn attachment; the customer completes the authorization without a notary.
- How do I submit the Utility Disclosure Form?
- The document says to return the form but does not provide a submission address or contact details. Submit it to the city department named on the form and check the city website for current contact details.