Life Support Application

Cowlitz PUD maintains a list of customers who cannot live without the use of electrically powered medical equipment.

The utility also maintains a list of customers who rely on electricity for medical reasons, but whose dependence on electricity is less critical.

The District recognizes that some customers or household members require life support equipment that operates on electricity in their home. A customer or household member who requires such life support equipment, can request their account be designated accordingly by submitting a Life Support Equipment Application to Customer Service. The application must be properly document by a medical physician, and approved by the District in writing.

Customers who participate in the Life Support Equipment Policy understand and agree that the district will make reasonable efforts to provide participants with the benefits described in this policy, but the district cannot assure customer will receive timely notice of the loss of power in all circumstances. Customer expressly releases the District from any and all liability arising out of, or in connection with, the District’s negligence, and that of its employees, agents, and commissioners. Customer will make arrangements to assure themselves of receiving necessary Life Support Services as an alternative to any electric services provided by the District.

Having this designation does not guaranty uninterrupted power. Life support customers are responsible for having a backup power source and/or relocating to an alternate place during extended outages.

Customers who participate in the Life Support Equipment Program are subject to any other applicable policies of the District.

After receiving your request, a customer representative will contact you for more information.

There are two ways to submit a request. You can download and complete the Life Support Customer notification form (PDF) in full and return to our office through email at customerservice@cowlitzpud.org or through the mail at:
Cowlitz PUD
PO Box 3007
Longview, WA 98632

Or you may fill out the form below and submit it electronically. Please note that Physician’s Signature is still required and will require printing this form. There is a print button underneath the title at the top of this page.

  • Date Format: MM slash DD slash YYYY
  • This explanation must describe in detail the device and its role in supporting life.
  • Customers who participate in the Life Support Equipment policy (subsection 4.2 of the Customer Service Policy) understand and agree that the District will make reasonable efforts to provide participants with the benefits described in this Policy, but the District cannot assure customer will receive timely notice of the loss of power in all circumstances. Customer expressly releases the District from any and all liability arising out of, or connect with, the District’s negligence, and that of its employees, agents, and commissioners. Customer will make arrangements to assure themselves of receiving necessary life support services as an alternative to any services provided by the District.
  • Date Format: MM slash DD slash YYYY
  • *Physician's Signature is required. Please print a copy of this form for your physician to sign if your physician is not present to sign it. Return the signed form to Customer Service at customerservice@cowlitzpud.org or by mailing it to PO Box 3007, Longview, WA 98632
  • Date Format: MM slash DD slash YYYY
  • This field is for validation purposes and should be left unchanged.