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Request For Change Of Mailing Address To A Third Party Address

Member Information (US Residents apply only)

Promo ID:

Type your name as you would like it to appear on your account.

First Name

Middle Name

Last Name

Suffix

E-mail Address

Membership Plan

Select plan: (your credit card or bank account will be charged based on the plan you choose below)

Residential

Business

Contact Information

Address 1: (include apt.#)

Rent/Buy/Own

City

State

Zip

Previous Address: (If less than 2 years at your current address)

Address 2: (include apt.#)

City

State

Zip

Home Phone

Business Phone

Utility Company Information

Type your name as you would like it to appear on your account.

Utility Company / Account# Est. Monthly Avg. Utility Company Address
Electric
Water/Sewer
Natural Gas
Cable
Local/Long Distance
Internet

Submit my application. By electronically transmitting this application, I indicate my agreement with each of the conditions described below. Submitting this application customer and requester acknowledge that account information affected by this request for change of mailing address includes all utility bills (gas, electric, water, telephone, cable, internet), bill inserts, discontinuance notice and other information normally sent to the mailing address on the account.

I authorize my utility providers (listed above) to change the mailing address on the accounts listed on this form. I understand that, as a result of this change of address request, I may no longer receive the bill, discontinuance and other notices, and related information. I further understand and represent that this change of address form authorization does not confer any rights or privileges upon the third party bill recipient to act on my behalf. I release my utility providers (listed above) from any claims, damages or expenses associated with my failure to receive the bill, discontinuance and other notices, and related information and I release my utility providers (listed above) from any claims, damages or expenses resulting from the unauthorized account information. I further certify that I have authority to authorize the change of address for the account listed on this form.

I have read this application, and everything I have stated in it is true. I authorize Flatrate-Utilities.com to check, employment history, or any other information and to report to others such information I understand that the acceptance or use of any account issued will be subject to the terms of this application and the Account Agreement that will be sent to me, and I agree to be responsible for all charges incurred according to such terms. I am at least 18 years of age. I consent to and authorize Flatrate-Utilities, any of its affiliates, or its marketing associates to monitor and/or record any of my further conversations with any of the Its representatives or the representatives of any of those companies to better ensure quality service. This program is issued and administered by Flatrate-Utilities.

Information about me or my account may be shared among Flatrate-Utilities and its related companies for marketing or administrative purposes. I may prohibit such sharing of information, other than information pertaining solely to transactions or experiences between me and Flatrate-Utilities (or a Flatrate-Utilities company), by writing to Flatrate-Utilities, at 16690 Champion Forest Drive, #170 - Houston, TX 77379 and including my name, address, home phone number and all Flatrate-Utilities account number(s).

Flatrate Utilities
4226 Bayglen Ct.
Houston Texas. 77068

Fax: 832-579-1076

This change of address should take effect on 30 days after your next billing date.