350 South Interstate 35 East Denton, Texas 76205
Menu
Call
379058C5-BD0D-42F4-B7B1-E2D1179556D2
Pay Bill Online
Home
Consumer Access Request Form
Consumer Access Request Form
Consumer Access Request Form
* indicates a required field
First Name
*
Last Name
*
Date of Birth (Day)
*
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Date of Birth (Month)
*
1
2
3
4
5
6
7
8
9
10
11
12
Date of Birth (Year)
*
Email Address
*
Phone
*
Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Zip Code
*
Information Being Requested
Specific pieces of personal information, collected or shared with third parties and for what business/commercial purpose.
Request to delete data.
We do not sell personal information that we have collected from consumers to any third parties. By completing this form, you are making a Consumer Access request under California Consumer Privacy Act for personal information collected, held and disclosed about you that you are entitled to receive. On this date [today_date], I affirm that I am the consumer, or authorized by the consumer to act on their behalf. I understand that misrepresentation may be subject to legal action.