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2. Public Records Request
   The Benbrook Water Authority is pleased to comply with your request for information. We do, however, require you to provide the following information as it applies to you and ask that you be very specific in your request.
4. Name*
5. Email Address*
7. Company Name
9. Address*
11. City*
12. State*
13. Zip Code*
15. Phone Number*
16. Fax Number
18. What is your specific information request? Be very detailed.*
20. Preferred format:*

    1. Electronic (if available)
    2. Paper
22. Preferred Delivery*

    1. Pick Up
    2. U.S. Postal Service
    3. Email
    4. Fax
24. Costs*

    I understand that there is a charge of $.10 per page for standard paper copies and $.50 per page for non-standard paper copies, plus any applicable charges for providing information as outlined in Title 1, Part 3, Chapter 70, of the Texas Administrative Code. If the estimated charges are more than $40 BWA will contact me prior to the completion of my request.

    1. I have read and understand about the costs associated with this request.
28. Electronic Signature*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree
30. Electronic Signature*
Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field