Application Form

SMALL BUSINESS & NONPROFIT ENERGY ASSISTANCE PROGRAM

Customer Information
Customer Account #:
Customer Name:
Customer Billing Address:
Address: Address Line 2:
City: State:   Zip:
Contact Person:
First Name: Last Name:
Contact Phone:
Email Address:
Re-Enter Your Email Address:
Type of Organization
Charitable nonprofit organization (mission-driven 501(c)3 corporation)
Community center - Senior center or Adult day-care services
Cooling center
Faith-based organization
Homeless services center
Learning institutions
People with disabilities or supportive living center
Youth or Day care centers
Small Business Customer, defined as
  • An independently owned and operated business with its principal office in Illinois
  • Gross Sales less than $4 million or has 50 or fewer full time employees
Other (please describe)
Hardship
I have read and agree to the terms and conditions of the Information Request and Consent Form.