TERMS/CONDITIONS
Terminology
For the purpose of this document, terms 'I' and "My" refer to the applicant.The term "Organization" refers to Love is What Love Does. The term "Vendor" refers to the utility company.
I agree and understand my information will be kept secure and confidential in compliance with the highest level of Jotform security and adherence to HIPAA regulations. I understand my information will be used only for the purpose of service and program data reporting. I understand I can withdraw my application at any given time from the organization and its affiliates. I understand Love is What Love Does reserves the right to approve or deny my application based on organization's policy, in which I have been advised of the content. I understand submission of application does not in any way guarantee financial assistance. I understand failure to report accurate information during intake could result in disqualification of service. I understand Love is What Love Does application process does not use discriminatory practices based on race, sex, age, religion, or disability. I give Love is What Love Does permisison to access all details of my utility account with said vendor for the purpose of processing my service application. I give the organzation permission to access but not limited to the following: balance information, account status, and payment or pledge history. I understand I can revoke access to my utility account at any given time. However, I understand the organizaton may not be able to serve my needs without access to my utility account with said vendor.
I acknowledge and have reviewed the Terms and Conditions. I, hereby, release Love is What Love Does organization from any liability regarding transmittal of my personal information as provided in the above application. I have been given the opportunity to question any terms and conditions before providing my signature on the next page.
