Shallowater, TX · Lubbock County
Consent to Disclose Utility Customer Information
Shallowater utility customers use this form to authorize or decline disclosure of customer information to a requesting entity.
What this form is
This form lets a customer authorize or decline disclosure of utility account information, including balance, payment history, and usage per billing period. It asks for the account number, service address, customer names, signatures, date, and phone number. Customers may withdraw consent by sending a written request with their name and service address to the utility.
Who needs it
A Shallowater utility customer who wants to authorize or decline disclosure of their account information to a requesting entity should complete this form.
How to submit it
Return the completed form to the utility by email at [email protected], fax at (806) 696-4300, or mail to City of Shallowater, PO Box 246.
About notarization
This form is signed and dated without a notary; it does not mention any attachment or related step that must be notarized or sworn.
How to submit this form
- 1
Download The Form
Download the Consent to Disclose Utility Customer Information form.
- 2
Complete The Form
Select whether to authorize disclosure or decline it, then provide the account and customer details requested.
- 3
Sign And Date
The customer or customers of record sign and date the form and provide a phone number.
- 4
Submit To The Utility
Return the completed form by email, fax, or mail using the contact details printed on the form.
Frequently asked questions
- Do I need a notary for this consent form?
- No. This form is signed and dated without a notary, and it does not mention any attachment or related step that must be notarized or sworn.
- How do I submit the utility information consent form?
- Return it to the utility by email at [email protected], fax at (806) 696-4300, or mail to City of Shallowater, PO Box 246.
- What information does the form ask for?
- It asks for the customer account number, service address, printed customer names, customer signatures, date signed, and customer phone number.
- Can I change my consent later?
- Yes. You may terminate consent at any time by sending a written request with your name and service address to the utility.