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Assistance is available for the four (4) utility bills due on August 20th, September 20th, October 20th, and November 20th. Only one application is required in order to be eligible for assistance on each of the four bills. Up to $100 per bill period will be applied to the approved applicant’s utility account. This funding will apply to the current bill AND applicable payment plans dating back to February 20th, 2020.

If $100 does not cover the entire amount due, customer must pay the difference in order to avoid potential discontinuation of services

I certify and attest that the information I have provided to determine my eligibility for utility assistance through the City of Archdale (via CARES Act funds) is true and complete to the best of my knowledge. I understand that if the City discovers new information that indicates I am not eligible for the program, my participation can be cancelled. I agree to provide, upon request, documentation on all income sources in order to prove eligibility for assistance under Federal CARES Act regulations.

Title 18, Section 1001 of the U.S. Code states that a person is guilty of a felony for knowingly and willingly making a false or fraudulent statement to a department of the United States Government.

I understand that information provided in this application is confidential in regard to my City of Archdale utility account, but that portions may become public record as documentation for federal funding. I further acknowledge that my eligibility for utility funding assistance is based on having a qualifying annual family income level AND having been negatively impacted by the COVID-19 pandemic. I understand that failure to provide complete and accurate information may be the basis for rejection of my application. My signature below attests that all information provided is accurate to the best of my knowledge.

By checking the "I agree" box below, you agree and acknowledge that: 1) your application will not be signed in the sense of a traditional paper document 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

I agree. Electronic Signature

Electronic Signature*

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COVID-19 Utility Assistance Program : Application

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