Electric Account Age Verification

Electric Account Age Verification

Confirm your age and eligibility for Winter Shut-off Protection as a senior citizen. To qualify automatically for Winter Shut-off Protection, you must be 65 years or older. For assistance with this form, please call 616-355-1500 or visit our Service Center (625 Hastings Ave) during office hours.
Please note that submitting this form does NOT provide a discount or payment plan. Verifying your eligibility as a senior citizen protects you from shut-off during the heating season (November 1 - March 31). If you have concerns about paying your bill or would like to enroll in a payment plan, please contact us.
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email
example@example.com
Electric Service Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Holland BPW Electric Account Number*
Where can I find my account number?
Please upload a photo or scan of your driver's license or other form of ID listing birthdate to verify your age.*

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