REQUEST FOR INFORMATION 
from
 Two Rivers Authority


NAME: _______________________________________________________________________

COMPANY: ___________________________________________________________________

COMPLETE ADDRESS: _________________________________________________________

_________________________________________________________

TELEPHONE NUMBER: ________________________ FAX NUMBER: ____________________


 SIGNATURE: _____________________________________ DATE: ______________________


INFORMATION REQUESTED:____________________________________________________

_____________________________________________________________________________

_____________________________________________________________________________


Total pages ____________________ @ 50¢ per page = Amount due:______________________

The documents will be ready for mailing or pick up within ten (10) business days after TRA receives
 this completed form and a (business or certified) check or postal money order for the full amount.

Request received by: ________________________________ Date: _______________________

Payment received by: _______________________________ Date: _______________________

Info delivered by: ___________________________________ Date: _______________________

Packet received by:_________________________________ Date: _______________________

Two Rivers Authority
406 N. Cheyenne Ave.
Hardin, MT  59034

Print page ~ then mail completed form and payment  to address below