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COVID-19 Self-Certification

  1. Did You (and/or spouse):

  2. Did you Receive:*

  3. Did your household income:*

  4. Have you made payments on your Freeport Electric account since March 1, 2020?*

  5. If necessary, you may be required to provide proof of any of the above questions. This proof would only be used by Freeport Electric to determine eligibility and terms of SPA and/or Shut-off. By signing below, I attest that due to the COVID-19 state of emergency, which began on March 7, 2020, I have experienced a change in financial circumstances.

  6. Leave This Blank:

  7. This field is not part of the form submission.