Financial Hardship Statement - Hull Municipal Light Plant

Financial Hardship FORM

This is a GOOD FAITH PAYMENT towards your outstanding balance. While it is our sincere goal to assist you, it is your responsibility to stay in contact with HMLP regarding your account. Alternatively, you can download, print, and return the completed form to our office.

Financial Hardship

If you have a financial hardship, your electric account may be protected from termination for non-payment for the following reasons:

Someone in your household is seriously ill (a doctor’s letter is required)

You have a child under the age of 12 months (birth certificate required)

Did you qualify for Fuel Assistance last winter?

Yes

No

(Documentation Required)

Have you applied for Fuel Assistance this year?

Yes

No

(Documentation Required)

First Name

Last Name

Account Number

Service Address

Mailing Address

Phone

Email

Number of persons in household

Total monthly income of ALL residents

INCLUDING: Salaries, Child Support, AFDC, Social Security Disability, ETC

Payment amount per agreement

Select One

Monthly

Weekly

Signature

Clear

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