More in this section Credit reference letter request * = Required field A credit reference letter can only be requested the person whose name is on the account. The letter will include: the dates your service started and stopped; how often in the past 12 months you were in arrears (30, 60, or 90 days); had NSF cheques; were disconnected for non-payment. Name * Manitoba Hydro account number * Current street address * City/town * Postal code * Phone * Email * Service address in Manitoba Same as above Street address City/town Postal code I authorize Manitoba Hydro to release this information to: Utility company information Company name * Fax Street address * City/town * Postal code * Province Manitoba Alberta British Columbia New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon I certify that I am an owner of the account specified above, and that I am fully authorized to execute this form. I/We hereby authorize Manitoba Hydro to provide the credit reference letter, in any form, format, and medium, deemed appropriate by Manitoba Hydro, to the Recipient. I acknowledge and agree that Manitoba Hydro is not responsible for any action or inaction of the Recipient with respect to the credit reference letter or any information contained therein which may cause loss or damage to me, including, but not limited to, loss of, unauthorized use of or transfer of, any information contained in the credit reference letter. I hereby agree, and shall cause any other account owner(s) to agree, that Manitoba Hydro, and its officers, directors, employees, affiliates, agents, successors and assigns, shall not have any liability for any direct or indirect damages that may result from, be caused by, or arising out of or in any way connected with the credit reference letter and/or any information contained therein. By completing and submitting this form, I consent to my account information being released to another utility.