PG&E Interview/Report Form

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Welcome to the PG&E Customer Arrears Case Management System

This page is for the Hmong Inc' to manage cases for customers of Pacific Gas and Electric. It will be used by to help you in applying for utility costs relief. If you are filling this out by yourself, please have a copy of your PG&E bill with you.

Email *

What is your name? *

What is the address on your PG&E Bill? *

What is your PG&E Customer ID number? (required to track your case) *

What is your PG&E Meter ID number? (optional)

What email address do you want to be contacted at? *

Please re-enter your preferred contact email address? *

What is your phone number where you can receive text messages? *

Please re-enter your phone number. *

Preferred contact method *

Phone

Required

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This form was created inside of Lord Santiago LLC.