Customer Contact Enrollment Form

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PILI WATER DISTRICT

Dear Valued Concessionaires:

As part of our commitment to deliver unparalleled customer service among our concessionaires, we wish to collect your contact information to deliver up to date announcements and billing details to your mobile phone through text or e-mail.

We assure our concessionaires that your right to privacy is protected in accordance with RA 10173 otherwise known as Data Privacy Act of 2012. PIWAD shall use your personal information to fulfill the above purpose, it shall not be used to any purpose that is contrary to law or in any manner which you were not notified of.

Thank you.

Email *

Account Name *

Code Number *

Account Number *

Please follow this format: 111-23-4567

Email Address *

Contact Number *

Only one contact number per account will be registered

I agree to register my contact details to receive: *

Service Update/Advisory

Bill

Required

I acknowledge and understand that for as long as I remain a concessionaire of the District, I am giving my consent to the use, processing and collection of my personal information by the District, its employees, representatives, and service providers, for the purpose/s stated and in the manner provided in the Privacy Policy Statement.

I understand that for any change of my contact details under my account, I shall update and enroll my new contact details to receive up to date information from the District.

Required

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