Follow the steps to successfully complete your application online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by completing Section 1, which captures information about the eligible property. Provide the account name, street address, city, account number, and zip code.
3. Proceed to Section 2 for customer contact information. Fill in the first name, last name, daytime phone number, email address, mailing address if different, city, state, and zip code.
4. In Section 3, you will attest to the COVID-19 economic hardship. Confirm that the utility fee arrearage is due to the economic impact of the pandemic. Indicate whether you have received assistance from the Rebuild Virginia Grant Fund or local CARES Act relief and provide an explanation of your COVID-19 related economic hardship.
5. Complete Section 4 with the applicant's certification. Read and ensure you understand the statements. Sign and date the application, including your title or position.
6. Once all sections are completed, review the entire form for accuracy and legibility. Save your changes and ensure that it is ready for submission.
7. Submit your application by email, fax, or in person as per the provided contact information. Ensure your application is submitted by the deadline of midnight on January 17, 2021.

Complete your application online today to access the support you need.