Get IL AIMS Program 2012

Disabled veterans please attach a copy of your Department of Defense 214 DD-214 form or discharge letter must be honorably discharged along with one of the following a copy of your award letter if your disability is related to military service or a copy of your Social Security disability letter if your disability is not related to the military 4. Send the completed and signed application along with the documentation noted above to Ameren Illinois. You may mail fax or email this information to us as noted below Signature Attn Energy Assistance A-10 AIMS Program PO Box 2543 Decatur IL 62525 Fax 1. Ameren Illinois Military Support AIMS Program To qualify for assistance through the AIMS program you must be a military member on active duty or a disabled veteran with a demonstrated hardship and have an active Ameren Illinois electric account. You will be contacted after your application has been reviewed* Only one grant is allowed per household. Please complete the required fields below Mark the appropriate box Active Duty Disabled Veteran Account Number Applicant Name Name listed on the account if different from above Address Phone Number City Email Can this email address be added to your Ameren Illinois account and used to communicate regarding your bill Yes No Mailing Address if different from above Street/P. O. Box State Zip Code Please briefly explain your hardship Directions 1. Complete this form entirely and make a copy for your records. 2. Active duty military members please attach your set of orders. Please note this does not include Change of Station papers* 3. Disabled veterans please attach a copy of your Department of Defense 214 DD-214 form or discharge letter must be honorably discharged along with one of the following a copy of your award letter if your disability is related to military service or a copy of your Social Security disability letter if your disability is not related to the military 4. Send the completed and signed application along with the documentation noted above to Ameren Illinois. You may mail fax or email this information to us as noted below Signature Attn Energy Assistance A-10 AIMS Program PO Box 2543 Decatur IL 62525 Fax 1. 217. 424. 6496 Email AmerenILCredit Ameren*com Date / By signing this document I do hereby attest that the information provided is true accurate and complete to the best of my knowledge. I understand that any falsification of material will cause the denial of my application for assistance through the AIMS program* I further understand that completion of this application does not guarantee a grant approval from the AIMS program and the program will continue as long as funds are available. Ameren Illinois Military Support AIMS Program To qualify for assistance through the AIMS program you must be a military member on active duty or a disabled veteran with a demonstrated hardship and have an active Ameren Illinois electric account. You will be contacted after your application has been reviewed* Only one grant is allowed per household.