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					                                                             Check Payment Information Sheet

Agency Name:________________________                                       Phone Number: ___-___-____                   Date:________________

                                          Check Number: __________             Check Date: __________          Check Amount: $__________



                      Account #                                 Account Holder/ Customer's Name:                     Current Service Address:               Pmt. Amount




                                                                                       Mail to: Vectren Attn: Credit & Collections P.O. Box 209 Evansville, IN 47702-0209
                                                                                                         Email Address: epace@vectren.com or jcornaire@vectren.com

Please verify the name, address, and account number on
the customer's bill is the same as what will appear on the
Check Payment Information Sheet submitted to Vectren.
                                                                          Pipp Applications
                                     Agency Name:__________________________     Phone Number:___-___-____           Date:_______________


                                                                                                                                           Last 30             Last 3
                                                                                   S.S.                                         No. in      Days              Months
                   Account #                           Customer's Name:            No.                   Address:                HH        Income    Source   Income




        Initial Pipp Enter: "Yes or No"                                             Fax to 812-491-4476 (Vectren Customer Relations)
                                                                                     Email Address: energyassistance@vectren.com
Please verify the name, address, and account
number on the customer's bill is the same as what
will appear on the Pipp Application submitted to
Vectren.
                                                    Emergency Assistance Intent to Pay

              Agency Name:________________________                                Phone Number: ___-___-____          Date:________________




                                                                                                                                                 175 Rule
               Account #                       Account Holder/ Customer's Name:         SSN:           Current Service Address:      Pmt. Amount Yes / No?




175 Rule Enter: "Yes or No"                                                                         Fax: 812-491-4476 (Vectren Customer Relations)
                                                                                                      Email Address: energyassistance@vectren.com

Please verify the name, address, and account
number on the customer's bill is the same as
what will appear on the Intent to Pay form
submitted to Vectren.
                                                      Appointment Worksheet

Agency Name:________________________________


Date:____________________________


                Account #                      Account Holder's Name:                                                                 Date of
                (19 digits)                      Customer's Name:                  SSN:                  Current Service Address:   Appointment


                                                                                            `




                                                                Email Address: energyassistance@vectren.com

Please verify the name, address, and account
number on the customer's bill is the same as
what will appear on the Appointment Form
submitted to Vectren.                                       Fax to 812-491-4476 (Vectren Customer Relations)

				
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