2. Instructions
   Please upload your supporting documents for your Utility Relief Credit application.
4. Name of Account Owner or Tenant*
5. Customer Utility Account Number*
7. Service Address*
9. Is this a Commercial or Residential utility account?*
11. Businesses: Please upload supporting business revenue documents for April-December 2019 & 2020 (e.g., Profit Loss Statement or other proof of revenue)
13. Residents: Please upload supporting household 2020 income documents (e.g., W2, 1099, tax return, or other proof of income)
15. Document upload*
17. Document upload
19. Document upload
21. Document upload
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23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

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