Billing History

Please send my last 12 months account history to my current mailing address.

Please allow up to 3* business days to process your request.

*If the form is incomplete or requires follow-up for further information, your request may be delayed.

indicates required field

Business name:

Account number:

Service Address:

City / State / Zip:

Please enter your City.

Please enter your State.

Please enter your ZipCode.

Owner/Manager:

Phone:

Please enter your Phone Number area code.

Please enter your Phone Number suffix.

Please enter your Phone Number line number.

Alternate Phone:

Please enter your Phone Number area code.

Please enter your Phone Number suffix.

Please enter your Phone Number line number.

E-mail address:

Verify e-mail address:

Identification Type: Federal Tax ID Social Security Number (last four digits only)

Please enter your Federal Tax ID

Please enter the first two digits of Tax Payer ID.

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Please enter the last seven digits of Tax Payer ID.

Please enter the last 4 digits of your Social Security number

Requested by:

IMPORTANT NOTICE ABOUT YOUR REQUEST: If you do not receive a confirmation e-mail after you have submitted this form, you may have provided an incorrect e-mail address or your spam filter, a system for blocking unwanted e-mail messages, may be switched on.

Business Billing History Form