Customer Information Authorization Requirements

If you are requesting specific information for an account, please include the customer's authorization and release of the information by attaching a Customer Information Authorization onto the Supplier Services contact form.

Maryland Customer Information Authorization

New Jersey Customer Information Authorization

Ohio Customer Information Authorization

Pennsylvania Customer Information Authorization

The Customer Information Authorization should include:  

  • Customer Name
  • Customer Address
  • Customer Account Number
  • Customer Signature
  • Who the information is released to
  • Specifically what information is released

With the request, please include:  

  • Requesting Name
  • Requesting Address
  • Requesting Phone / E-mail
  • Information Requested
  • Time Period of Requested Data

If you have any urgent questions, please contact us by phone at 330-761-4348.