Travis County

Water Control and

Improvement District

No. 19

c/o SiEnvironmental
2306 RR-620 N
Austin, TX 78734
512.402.1990

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Notice of Confidentiality and Right to Request Disclosure

- Utility Services

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- Notice of Confidentiality and Right to Request Disclosure: Pursuant to Section 182.051, Texas Utilities Code, a Customer’s personal, utility usage, and billing information is confidential and may not be disclosed by (DISTRICT) to third-parties unless a written request for disclosure is submitted by the customer. You may request disclosure of this information by completing This Form and returning same to:
  
  Travis County WCID #19
  c/o AWR Services, Inc.
  500 North Capital of Texas Hwy.
  Building 1, Suite 125
  Austin, TX 78746
  
  OR COMPLETE THE FORM BELOW AND SUBMIT IT
  _______________________________________________________________________
- I request disclosure to third-parties of my personal information and information related to my utility usage and amounts billed or collected as specified under Sec. 182.052 Utilities Code.
- Date REQUIRED Please fill out this field. Please enter a date.
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Address REQUIRED Please fill out this field. Please enter valid data.
- By checking this box, I verify that I request Disclosre as stated above.
  I Agree Please select this field.
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