Details for Utility Special Needs Request Form

Name:Utility Special Needs Request Form

This document is for our current customers who have a special need or are medically dependent upon electricity. In the event of an emergency where electricity has been cut or turned off, this form will enable the proper authority to be notified so that assistance can be provided to the customer as soon as possible.

The City and the County special needs request forms are both included in this document.

*Please note: The individual must be medically dependent on the electric supply. Examples are: ventilators and nebulizers (to help breathing); wheelchairs; infusion pumps; blood glucose meters, apnea monitors, and other home monitoring devices.

Filename:SPECIAL NEEDS FORM (City and County).pdf
Filesize: 397.33 kB
Filetype:pdf (Mime Type: application/pdf)
Created On: 04/27/2015 15:49
Maintained by:admin
Hits:2108 Hits
Last updated on: 04/27/2015 15:49
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