Home Request for Support from ROUND UP Program

Request for Support from ROUND UP Program

Complete the Utility Bill Support Request Form below and submit it to the Utility Department. To submit the form electronically, click the SUBMIT button at the bottom of the page. All Utility Bill Support Request Form submissions are considered confidential. A member of the Community Review Committee will contact about your request. The committee may request additional information to document statements in your request for support to help pay your City of North Pole utility bill. Any awards are reductions in your utility bill and not cash payments.

Date*

Contact information

First name*

Last name*

Telephone*

Alternate telephone

Mailing address*

City*

State*

ZIP Code

Utility account information

Address Same/Different than mailing address

Address

City

State

ZIP Code

Utility bill request

Utility account number*

Amount of request*

Utility account status*

Reason requesting utility bill forgiveness*

Request for Support from ROUND UP Program

Contact information

Utility account information

Utility bill request

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