|
Type
your name as you would like it to appear on your account.
First:
Middle:
Last:
Suffix:
(Jr, III, etc.)
Social
Security:
E-mail Address:
| Utility
Company Information |
Utility Company / Account#
Est. Monthly Avg.
Utility
Company Address
(Enter
Numbers Only)
(include
street address, city, state, zip)
Electric
Water/Sewer
Natural Gas
Cable
Local/
Long
Distance
Internet
Submit
my application. By electronically transmitting
this application, I indicate my agreement with
each of the conditions described below. Submitting
this application customer and requester acknowledge
that account information affected by this request
for change of mailing address includes all utility
bills (gas, electric, water, telephone, cable,
internet), bill inserts, discontinuance notice
and other information normally sent to the mailing
address on the account.
I
authorize my utility providers (listed above)
to change the mailing address on the accounts
listed on this form. I understand that, as a
result of this change of address request, I
may no longer receive the bill, discontinuance
and other notices, and related information.
I further understand and represent that this
change of address form authorization does not
confer any rights or privileges upon the third
party bill recipient to act on my behalf. I
release my utility providers (listed above)
from any claims, damages or expenses associated
with my failure to receive the bill, discontinuance
and other notices, and related information and
I release my utility providers (listed above)
from any claims, damages or expenses resulting
from the unauthorized account information. I
further certify that I have authority to authorize
the change of address for the account listed
on this form.
I
have read this application, and everything
I have stated in it is true. I authorize
Flatrate-Utilities.com to check, employment
history, or any other information and to
report to others such information I understand
that the acceptance or use of any account
issued will be subject to the terms of this
application and the Account
Agreement that will be sent to me, and
I agree to be responsible for all charges
incurred according to such terms. I am at
least 18 years of age. I consent to and
authorize Flatrate-Utilities, any of its
affiliates, or its marketing associates
to monitor and/or record any of my further
conversations with any of the Its representatives
or the representatives of any of those companies
to better ensure quality service. This program
is issued and administered by Flatrate-Utilities.
Information
about me or my account may be shared among
Flatrate-Utilities and its related companies
for marketing or administrative purposes.
I may prohibit such sharing of information,
other than information pertaining solely
to transactions or experiences between me
and Flatrate-Utilities (or a Flatrate-Utilities
company), by writing to Flatrate-Utilities,
at 16690 Champion Forest Drive, #170 - Houston,
TX 77379 and including my name, address,
home phone number and all Flatrate-Utilities
account number(s).
Flatrate
Utilities
16690 Champion Forest Drive, #170
Houston / Spring, TX 77379
Phone: (713) 393-3093
Toll Free: (877) 824-3019
Fax:
(877) 824-3019
This
change of address should take effect on
30 days after your next billing date.
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