Form Center

By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

COVID-19 Utility Assistance Intake Form - Residential Customers

  1. COVID-19 Utility Assistance Intake Form - Residential Customers

    Submission of an application does not guarantee any or all of a customer’s account arrearages will be offset by CARES Utility Relief Funds.

  2. Address where utility service is provided:

  3. Please place mark beside the applicable cause of economic hardship if you or a person in your household has experienced a loss of income due to the COVID‐19 pandemic (check all that apply):*

  4. CARES Act assistance application may:

  5. - Provide assistance for bills dated March 1, 2020, to December 30, 2020, and may not be used for past due amounts prior to this time period or after this time period.

  6. - Funding is designed to be a one‐time opportunity with only one payment per household.

  7. - Funding can be used for the following bills:*

  8. Applicant's Certification of eligibility that the customer meets the requirement for the program

  9. Electronic Signature- By adding your name here you agree that everything above is correct and submitted by you.

  10. Leave This Blank:

  11. This field is not part of the form submission.