Summer Cooling Assistance Application

Summer Cooling Assistance Application

One (1) Electric Bill per elder household will be processed for the Summer Cooling Assistance. Electric Bill will be the only bill paid during this incentive up to $100 on CURRENT AMOUNT only. If you are on AVERAGE/BUDGET/LEVELIZED BILLING, we will pay towards billing plan up to $100. Pre pay accounts will receive $100 in electric bill assistance, provide app/pre pay statement. No past due, disconnects, reconnections or deposits allowed. If you have a “ZERO” or “Credit” balance, NO payment will be made. Must submit your complete current electric bill, if bill is not in your name, you must have a Residence Verification form. This incentive will exclude any light charges and any extra equipment charges. **Does not affect your 90-day assistance****Last day to submit a bill is the day it is due**
Print Name:*

First NameLast Name
Always provide your CDIB# 2801A*
Spouse's Name:

First NameLast Name
Date of Birth:*

MonthDayYear
Date
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:*

Area CodePhone Number
Message Phone:

Area CodePhone Number
2025 Summer Cooling Assistance Application
Electric bills accepted beginning August 1, 2025 through September 5, 2025
**No applications/bills will be accepted after September 5, 2025**
If you have any questions, please contact our office at 405-422-7411
Electric Bill:

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