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Billing History Form

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.

Please enter the Business name.
Please enter a 12 digit account number starting with the number 2, 3 or 4.
Please enter your Service Address.
Please enter your Service City.
Please enter your Service Zip Code.
Please enter the name of the Owner/Manger.
Please enter your Phone Number area code.
Please enter your Phone Number suffix.
Please enter your Phone Number line number.
Please enter your Alternate Phone Number area code.
Please enter your Alternate Phone Number suffix.
Please enter your Alternate Phone Number line number.
Please enter your Email Address.
Please verify your Email Address by entering exactly (it's case sensitive) as above.
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 Federal Tax ID.
Please select an Identification Type.
Please enter the last 4 digits of your Social Security number.
Please enter the name of the person making this request.

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.

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