Utility Assistance Intake
Thank you for submitting your application. Please note that we do not have sufficient funds to accommodate every applicant.Our team will carefully review your application within 3–5 business days. You will receive an update on the next steps via email once the review process is complete.Thank you for your understanding and patience.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
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Utility Company
*
Please Select
TXU
Atmos
McKinney Water
Account Number
*
Please verify your Account #
Amount you owe on bill
*
*****If over $500 you will not qualify for assistance.*****
Please give us a little information on your crisis( This is the reason you are unable to pay the bill)
*
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How many in the Household (Including all adults and children)
*
What is your income Range?
*
0-25,999.99
26,000-50,999.99
51,000-75,999.99
over 76,000.00
Please ensure that you have uploaded all of the items listed on the checklist below; otherwise, your application will not be processed. If all documents are not uploaded, we will proceed to the next in line.
Upload ALL of The Requested Documents Here:
*
Browse Files
Drag and drop files here
Choose a file
Please make sure all Documents are clear and legible or we will not process your application for assistance
Cancel
of
Please sign here that you understand submission of your application and documents Does NOT guarantee approval of your case. Assistance is based on eligibility and funding.
*
Submit
Submit
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