Get Certification Utilities Moratorium Form

The Certification Utilities Moratorium Form is essential for users seeking to secure continued electric or gas service under specific eligibility requirements. This guide will help you understand each component of the form and provide clear instructions for filling it out online.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by providing the name of the electric or natural gas company and their address at the top of the form. This section helps identify which utility's services you are requesting to continue.
3. Enter the date of filling out the form, along with your city and state. Make sure this information is current to avoid any delays in processing.
4. In the section regarding your household’s circumstances, indicate whether a member of your household is elderly (65 years or older) or has a disability. Provide the names and ages of those individuals.
5. If applicable, provide a brief description of the disability for the household member with a disability and indicate if they have been certified as disabled by a governmental agency. Specify the name of the agency if the answer is 'Yes.'
6. Certify that you are unable to pay your electric or gas bill in full by stating your financial situation. Clearly articulate that you cannot make any payments in six monthly installments after covering your essential monthly expenses.
7. Certify that your household meets the eligibility requirements for the Low Income Energy Assistance Program, so that the utility company understands your status.
8. Complete the certification statement, confirming that the information you provided is true. Include your printed name, signature, and the date to authenticate your application.
9. If you have your account number, enter it along with your service address to assist the utility company in processing your request.
10. Finally, submit the form according to the utility company's submission guidelines. This may include saving changes, downloading, printing, or sharing the completed document as needed.

Complete your Certification Utilities Moratorium Form online today to ensure your continued utility services.