Please complete this form to apply for COVID-19 assistance on your utility bill. Qualifying customers will receive a one-time credit equaling 50% of their May 2020 utility bill, up to a maximum $300 credit and the remaining balance can be setup on a 6-month payment plan. If approved, please allow 1-2 weeks after the May billing statements go out for the credit to be applied to your account.
Billing Address (if different):
Date First Impacted by COVID-19:
Were You Laid Off From Work or Lost Your Job Due to COVID-19?
If Yes, Name of Workplace:
Has Spouse or Any Members of Household Been Laid Off/Lost Job?
Are You or Spouse Currently Receiving Unemployment?
If Yes, Weekly Amount:
If approved, do you want your balance put on a 6 month payment plan?
Reason for Applying:
I acknowledge that the information given above is true and correct to the best of my knowledge. I understand this is a one-time credit and I am still responsible for my bill.
Account Holder Signature: