Get Application For Additional Baseline ... - Southwest Gas

This guide provides detailed instructions on how to fill out the APPLICATION FOR ADDITIONAL BASELINE ALLOWANCE for qualified medical conditions via an online form. By following these steps, users can ensure they complete the application accurately and efficiently.

Follow the steps to complete your application online.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling in the customer information section. This includes entering your name, service address, and mailing address (if different). Ensure accuracy in the details provided.
3. Provide your telephone number and account number. Double-check these entries to avoid any interruptions in service or communication.
4. Indicate whether you would like information regarding ‘Third Party Notification’ by selecting either 'Yes' or 'No'.
5. In the declaration of eligibility section, sign and date the form. Insert the name of the eligible individual who resides in your household and select their medical condition from the provided options.
6. Acknowledge your understanding of the requirements related to the additional baseline allowance by reading the accompanying statements carefully before signing.
7. If applicable, ensure that a physician or licensed medical professional fills out the letter of certification section. They should provide their contact information, business address, and registration number.
8. Once you have completed the form, save your changes. You may then choose to download, print, or share the completed form for submission.

Complete your APPLICATION FOR ADDITIONAL BASELINE ALLOWANCE online today to receive the support you need.