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American Electric Power West Texas Utilities 

CUSTOMER AUTHORIZATION FOR THE RELEASE OF PROPRIETARY INFORMATION

Customer Name:

 

Customer Address:

 

City and State:

 

Zip:

 

Customer Telephone Number:

 

Account Number(s) or ESI ID(s):

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I, as the authorized representative for the above named customer, authorize the release of the following information:

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

Request Interval Data (Check if Yes) ____   

Interval Data File Format (Select one)   Excel _____   Lotus 123 _____  Comma Delimited Text ____

 

I hereby request that the information be released to:

Name: ____________________________________________________________________

Company: _________________________________________________________________

Address: __________________________________________________________________

Phone Number: ______________________      Fax Number: ______________________

Email Address:________________________________(required only if interval data requested)


Authorized By: ____________________________________________________________


Printed Name: _____________________________________________________________
Social Security #-Required only if residential account: __________________________________________________________________________
Title: _____________________________________________________________________
Date: _____________________________________________________________________

Return Completed Form To:
Fax: 817-498-9820 OR 978-246-6148

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