Project Pal

OPALCO Account Number*

Member Name*

Email*

Phone*

Street Address

Are you receiving any of the following assistance?*

Select or enter value

Please upload your documentation of assistance you receive.

Drag and drop files here or

Let us know any special circumstances that are affecting your household.

Are you a full-time resident?

Yes

No

Have you been an OPALCO member for at least 4 months?

Yes

No

Would you like to round up your monthly electric bill to support the Pal program?

Yes

No

VOLUNTARY Demographic Information

Why do we ask? This information helps us access grants and other funding opportunities to better serve you!

Veteran?

Yes

No

Disabled?

Yes

No

Send me a copy of my responses