Customer Hardship Assistance Requests

Central Arkansas Water (CAW)

Customer Hardship Assistance Request

CAW remains committed to assisting customers experiencing difficulties paying their utility bills due to significant weather events (such as storms, floods, or extreme temperatures) or life events (such as medical emergencies, loss of employment, or family crises). Our goal is to provide temporary relief and flexible payment solutions to help our valued ratepayers maintain essential utility services during challenging times.

Please complete the form below to request a review of your account. All requests will be evaluated according to CAW's Customer Assistance Policy.

Customer Name*

First NameLast Name

Customer Account Number*

Phone Number*

Please enter a valid phone number.

Email

example@example.com

Service Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date Hardship Began:*

Date

Type of Hardship (please select one or more options):

Brief description about your hardship circumstances:

Type of assistance requested (please select one or more options):

Please upload your hardship supporting documentation:

Customer Hardship Assistance Eligibility Criteria:

Per CAW's Customer Assistance Policy, customers may qualify for assistance if they experience one or more of the following circumstances:

· Severe weather events impacting property or income (e.g., tornadoes, floods, winter weather)

· Medical emergencies or hospitalization resulting in loss of income

· Loss of employment or significant reduction in work hours

· Death or serious illness in the immediate family

· Other unforeseen circumstances causing financial difficulty

CAW will accept the following documentation:

Insurance claims, repair estimates, or news reports for weather events
Medical bills, hospital discharge papers, or doctor’s notes for health-related events
Termination letter, unemployment benefits statement, or pay stubs for employment-related events
Other relevant documents as requested by customer service

All information provided will be kept confidential and used solely for the purpose of assessing eligibility for assistance.

For questions about this assistance process, please contact the CAW Customer Service Department at:

· Phone: (501) 372-5161, option 6

· Email: CustomerService@carkw.com

Customer Assistance Policy Acceptance:*

I declare review of CAW's Customer Assistance Policy eligibility guidelines and the information provided within this form is true and correct to the best of my knowledge.

Signature*

Date

Customer Hardship Assistance Requests

Central Arkansas Water

New Service

Hardship Information:

Assistance Requested:

Supporting Documentation:

Confidentiality Commitment

Questions - Customer Assistance Process