Application for Utility Assistance

Application for Utility Assistance

Required documents must be uploaded directly for on-line applications. If you do not have access to a Full and Complete Monthly Bill - Please contact your utility company to request a copy.
Utility Assistance Policy

Must live in CCF Service Area (Sapulpa, Kellyville, Kiefer and Eastern Creek County). Assistance amount is up to $100 / per household / per 12 months. Bill must be in your name and current address (or in the name of a current member of your household). We are unable to assist with deposits or balances from a previous address. In order to process requests, applicants must meet eligibility requirements and submit proper documents. It generally takes between 1-3 business days for CCF to issue a pledge. CCF makes financial pledges and sends payments directly to the utility company.
This is an application for Emergency Utility Assistance. CCF requires an actual full and complete month's billing statement from the utility company. The Due Date or Cut-Off Date may NOT be more than 48 hours from Today. Do you understand that your application will not be processed without a full and complete bill that is past due or due within the next 48 hours?*

YesNo
Date

MonthDayYear
Date
Where do you live?*

SapulpaKieferKellyvilleCreek County Resident with Tulsa AddressCreek County Resident with Mounds AddressAll Others - Call 211 or go to www.211EOK.org to find help in your local area.

Documentation
I understand that I must submit all of the required documents (*) to complete my application and that my application may not be processed or approved without a full and complete bill that is past-due bill or due within 48 hours from today*

YesNo
Is the Bill in your name and current address?*

YesNo
Is the Bill in the name of someone currently living at that address?*

YesNo
Last 4 Social Security Number of the Account Holder (individual whose name is on the bill)*
Photo ID of the Account Holder (individual whose name is on the bill)*

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Proof of Income (paystub, social security, bank statement, etc.) If zero, please move on to the next question.

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Utility Bill. Please contact your utility company, if you need a copy of your bill. Must be the complete bill from the utility company. [a screenshot of account summary will not be accepted] Must include utility company information, monthly usage, current balance, account number, name, and service address. Due Date may NOT be more than 48 hours from today. *

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Applications must be complete and include the proper documentation. It generally takes between 1-3 business days for us to process your application. If the application is approved, we will contact the utility company to issue a pledge. Payment will mailed directly to the utility company.
Questions? Comments? You may use the space below, Call: 918-224-6464 (M|W|F), Email: info@ccfok.org, or In-person: 12 W. Burnham (M|W|F). Client Service hours Monday, Wednesday, Friday: 9:30 - 12:00 p.m. and 1:00 - 3:00 p.m.

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Application for Utility Assistance

Utility Assistance Policy

Personal Information

Household Information

Documentation