Release of Information - TID Water & Power

Required fields are marked with an *

TID Customer Information

Customer Name (as it appears on TID bill)*

Customer Mailing Address*

Customer Phone*

Please enter your Phone Number in the following format: (###) ###-####

Send Copy to Customer (select one)*

E-Mail
US Mail
None

Customer Email*

Please enter your Email in the following format: johndoe@email.com

TID Account Information

TID Account Number*

Your TID Account Number is a 10 digit number located in the upper left corner of your statement below the TID logo. Please enter it in the following format: ##########

Service address is the same as the mailing address?

The service address is the same as the mailing address above

Yes
No

Address where installation is occurring*

Add additional lines by clicking the + sign at the end of the row.

Installation Address	City

Billing History*

24-Month History
36-Month History

Other (Please detail)

Requesting Party*

I’m a TID customer requesting this information for myself.
I’m a contractor requesting this information on behalf of a TID customer.

Contractor/Vendor Information

Contractor Name

Business Phone Number*

Please enter your Phone Number in the following format: (###) ###-####

Mailing Address*

Representative Name*

Representative's Title

Representative's Phone Number*

Please enter your Phone Number in the following format: (###) ###-####

Send Copy to Contractor (select one)*

E-Mail
Mail
None

Contractor's email address*

Please enter your Email in the following format: johndoe@email.com

Customer Signature and Acknowledgement

TID Customer*

By checking this box I acknowledge that the execution of this form authorizes the release of billing history information and may include any of the following: Customer Name; Account Number; Service Address Information; Rate; Statement Dates; Service Dates; kW Usage and Bill Amounts.

TID Customer- Enter your name here to sign this form*

Title (if not the owner)

Last 4 digits of the California Drivers License or ID associated with this account*

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Comments

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