Data Protection Release | Pittsburgh Water & Sewer Authority

Please fill out the webform below if you require access to a history of your account information or are giving authorization to a third party to view your account information.

You can also print out this Data Protection Release Form and mail or email the completed form to:

Pittsburgh Water and Sewer Authority (PWSA)
ATTN: Customer Service
1200 Penn Avenue
Pittsburgh, PA 15222

info@pgh2o.com

Online Data Protection Release Form

*Your Name (Account Holder)

First

Last

*Your Email Address

*Customer 7 Digit Account Number

*Date

*Do you require access to a history of your account information or are you giving authorization to a third party to view your account information?

History Request

Authorization for a Third Party

I hereby authorize The Pittsburgh Water and Sewer Authority (PWSA) to release any information, including financial data, contained in my account to the following:

*Name of Third Party or Individual (If this is a history request, please enter your name)

*Service Address

Address Line 1

Address Line 2

City/Town

State/Province

ZIP/Postal Code

Mailing Address Same as Service Address?

Mailing Address (if different)

Address Line 1

Address Line 2

City/Town

State/Province

ZIP/Postal Code

*I agree to pay The Pittsburgh Water and Sewer Authority (PWSA) the standard charge that is applicable at the time for providing this service.

*Account Holder Electronic Signature

Sign above

*Signature Date

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