MID cannot guarantee uninterrupted electric service. I am responsible for continuous electric service in the event of power outages or disconnection of service due to non-payment. The Information on this application and required documentation is used to determine and verify my eligibility for assistance. All information is confidential and not shared with outside agencies. It is the customer’s responsibility to contact MID if your household income increases above the current limit and/or if the patient no longer requires the medical device(s). MID reserves the right to request further certification at any time while the MID customer is on the program. Misrepresentation of information, failure to disclose all income or failure to provide additional documentation, including tax records, as required by MID, may result in disqualification in the MLS program. MID will charge the customer the amount of the MLS discount inappropriately received in accordance with the MID Electric Service Rules. If eligible for MLS discount, I permit the proper discount to be applied to the service address listed above and give consent to have my eligibility verified. I declare, under penalty of perjury, that the information on this application is true and correct.
