EnergyAssistance

Energy Assistance Pledge Form

Energy Assistance

This form is to be used by various agencies, churches, and other organizations who offer utility assistance. Submitting the requested information will establish a Pledge for payment towards the account of an LP&L customer.

*Indicates a required field

Customer Information

Client Name:

First:*

Last:*

Client Address:*

Customer Name that appears on statement

First:*

Last:*

Service Address:*

Customer Number:*

Premise Number:*

Pledge Amount:*

Agency Information

Agency Name:*

Authorizing Person:*

Contact Number:*

i.e. 000-000-0000

Fax:

i.e. 000-000-0000

E-mail:*

Date Submitted:

A valid email address is required for confirmation that your request has been received. Please make sure your e-mail address and phone number are correct.

If you have any questions concerning your utility service, please contact us:

Telephone: 806-775-2509 Customer Service Fax: 806-741-1069
Mail: PO Box 10541, Lubbock, TX 79457
Locations: 1301 Broadway (Downtown) & 5217 82nd St (SW Branch)

Request For Service Applications

Energy Assistance Pledge Form