Customer 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.

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

Name
Address

Required: a letter detailing your dependence on electricity for support of life, signed by your physician, must be uploaded below. You will be added to the Life Support list after verification of the physician’s signature, address and phone number. Should a letter not be available, please print a form for your physician to complete and sign. Once complete, that form may be emailed with subject line: "Life Support" to (customerservice@cowlitzpud.org) or mailed by your physician to Cowlitz PUD – Attn: Life Support PO Box 3007 Longview, WA 98632. Incomplete forms will not be accepted.

Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx.
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