Consent to Disclose Personal Information

Please review the following carefully. If you have questions please don’t hesitate to contact us at or 210-602-3319 before completing the form.

  • This Agreement is made by and between Pecan Street Inc. (”Pecan Street”), and the undersigned (”Resident” or "I") (collectively, the ”Parties”).

    1.  I acknowledge that I am a participant in Pecan Street’s research program(s); I have received from Pecan Street, one or more residential energy devices (“Equipment”); and I have and continue to authorize Pecan Street to collect data from said Equipment pursuant to a Participation Agreement separately entered into with Pecan Street. I further understand that one of said Equipment is manufactured by appliance-maker, Itron Inc. (“Itron”) and that Itron is one of Pecan Street’s sponsored research Project Collaborators.

    2.  I understand that my name, household identity, and the physical address of my premises (“Residential Address”) from where Pecan Street collects Equipment data is all personally identifiable information which Pecan Street protects from disclosure to third parties, including its Project Collaborators.

    3.  I understand that in order to service (including repair or troubleshoot) the Itron-manufactured Equipment installed at my Residential Address, an Itron technician may need to know the exact or a proximate physical location of said Equipment. I further understand that Pecan Street’s research is dependent on properly functioning Equipment.

    4.  Pecan Street hereby requests my permission to disclose my Residential Address to an Itron technician exclusively for the purpose of servicing the Itron-manufactured Equipment on my premises, under Pecan Street’s supervision.

    5.  I acknowledge and certify that I fully understand the request herein and consent as follows:

    I authorize Pecan Street to disclose my Residential Address to Itron’s technician to be used for the sole purpose of servicing the Itron meter installed on the exterior of my house.

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