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Life-Sustaining Devices
Do you have
medical equipment that utilizes electricity in use at your
home? If so, we'd like to know. CEC will attempt to give those members advance
notice of any planned outages and priority in the restoration of electric
service whenever reasonably possible. Please note that this does not guarantee
that your electric service will not be interrupted.
To be included, please complete the form below and return it to the
Cooperative along with your doctor's certification. Your account must also be
kept up to date so that service is not disconnected for non-payment. An
application must be completed each year (CEC will send you a reminder and a new
form).
The possibility does exist that you may be without electric service for an
extended period when there is major damage to the electrical system. For this
situation, you may want to obtain an alternate power source such as a generator
or be prepared to relocate until power can be restored.
|
Life-Sustaining Devices |
| Account Name |
| Address |
| City, State, Zip |
| Telephone No(s) |
Account No. |
| Type of Equipment |
| Is Backup Available? |
Length of time backup can be used: _______ hours |
| Patient Name |
| Customer Relationship to Patient |
|
-Please Complete all Portions and
Attach Doctor Certification- |
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