Department of Public Service

Home Energy Fair Practices Act (HEFPA)
- Notification to Social Services of Customers Inability To Pay


[UTILITY name]


[Toll-free number]


Customer Name:________________________________________
City, State, Zip:________________________________________


Customer has been sent a final notice of termination. If the total payment due of $XX.XX is not paid by MM/DD/YYYY, termination of service may occur anytime after MM/DD/YYYY.

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