Name Change Request Form

Please Note:

The federal Red Flag Rule was passed on November 1, 2008. The law states that customer service is only allowed to speak with people listed on the account and only after verifying personal information. Texas House Bill 872 states a government-operated utility may not disclose personal and utility usage information for government-operated utility customers unless the customer requests that the government-operated utility disclose such information on an appropriately marked form or other written request for disclosure.

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Last Name *

First Name *

Cell Phone *

Work Phone

Service Address *

Drivers License Number *

Date Of Birth

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Name Change Authorization

I am requesting my name be changed to the following *

Reason for my name change *

Divorce (copy of divorce decree required)

Marriage (copy of marriage license required)

Death (copy of death certificate required)

Other (copy of other documentation)

Attach Required Documentation *

Files must be less than 2 MB.
Allowed file types: txt pdf doc docx xls xlsx.

Receive an email copy of this form *

Receive an email copy of this form.

Email address *