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


 

[UTILITY name]

[Address]

[Toll-free number]


 

Customer Name:________________________________________
Address:________________________________________
City, State, Zip:________________________________________
Account#:________________________________________

 

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.

Download one of the following files to use in your Word Processor:

MS Word Document
NOTIFICATION_TO_SS.docNOTIFICATION_TO_SS.doc

Rich Text Document
NOTIFICATION_TO_SS.rtfNOTIFICATION_TO_SS.rtf