Release Utility History | Ameren Missouri

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Release of Utility Historical Information

Questions?

This release authorizes Ameren Missouri to provide the historical data with regard to units of gas used for gas service for the following customer:

Customer Information

* required information

Company Name: *

Contact First Name: *

Contact Last Name: *

E-mail Address: *

name@domain.com

Confirm E-mail Address: *

Phone Number: *

555.123.4567

Fax Number:

555.123.4567

Service Address

* required information

Account Number: *

Where is this?

Address: *

Address:

City: *

State: *

ZIP Code: *

Add Another Account and Address

Account Number

The ten-digit number located on the Ameren bill for this service location.

Third Party

* required information

Company Name: *

What is a Third Party?

Contact First Name: *

Contact Last Name: *

Address *

Address

City: *

State: *

ZIP Code: *

E-mail Address: *

name@domain.com

Confirm E-mail Address: *

Phone Number: *

555.123.4567

Fax Number: *

555.123.4567

Please also send me a copy of this historical data report in addition to the Third Party specified above.

I affirm that I am the person who prepared this form, or that I have prepared and submitted this form as the duly authorized executor, guardian, authorized officer, or agent of such named person, and that I acknowledge that I have read and understood all of the questions in this application and that all of the information submitted in this application is true and correct to the best of my knowledge, and that all responses to the questions are full and complete, omitting no material information.

Third Party

A Third Party is a person or company that the customer has formally authorized to receive their historical data.

Any person who submits false or inaccurate information as part of this form may be subject to fines and/or punishment pursuant to applicable federal and/or state laws and regulations.