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Wcs Confidentialform C:\Documents and Settings\nora.BMTDOMAIN.000\Local Settings\Temp\CONFIDENTIALFORM.wpd

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BROWSE CITY OF BEAUMONT (TX) FORMS

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REQUEST FOR CONFIDENTIALITY
The Texas Utilities Code 182.052 allows for a customer’s right to request confidentiality of personal
information on their account. If you wish this confidentiality, please fill out the information below, sign
and return to Customer Service, PO Box 3827, Beaumont, TX 77704. A separate form should be
completed for each water account held.
DATE: ____________________ TELEPHONE: __________________________
ACCOUNT NUMBER: _________________________________________________
SERVICE ADDRESS: __________________________________________________
ACCOUNT NAME: ____________________________________________________
SIGNATURE: _________________________________________________________
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Completed 11 July 2020

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