Low-Moderate Income Bill Assistance Program
Attachments must be in one of the following formats: JPG or PDF. You MUST submit your application with ALL requested documentation below.
Must click the 'Submit' button to formally submit your application. Submission of an application does not guarantee that funding will be received.
I affirm that the information on this application, and all information I have submitted or will submit in support of this application, is true, correct and complete to the best of my knowledge, ability, and belief. I understand that I can be penalized by fine and/or imprisonment for making false statements. My signature on this application grants permission to contact any parties necessary to verify the information that I have provided.
I understand that I will be notified in the event that energy assistance funding is no longer available, or this application is denied.
I hereby authorize the utility company listed on this application to release my account number and account information. This includes arrearage information for the purpose of allowing ABCOG and entities acting on behalf of ABCOG to assess the effectiveness of services provided to consumers by ABCOG.
By checking this box I consent and agree that my electronic signature is the legally binding equivalent to my handwritten signature. I will not, at any time in the future, repudiate the meaning of my electronic signature or claim that my electronic signature is not legally binding.