Life Support Alert Program

Print
Press Enter to show all options, press Tab go to next option

Please correct the field(s) marked in red below:

LIFE SUPPORT ALERT PROGRAM

Anchorage Water Tariff Rule 7.1.B.5:

The Utility may extend the time for correcting a payment delinquency by an additional fifteen (15) days upon determining that the delinquency is for service to a dwelling occupied by a person who is seriously ill, elderly, handicapped or dependent on life support systems.

Special Note:

AWWU cannot guarantee uninterrupted service.  We request that the customer notify us by telephone immediately in the event of a water outage.

 *
LIFE SUPPORT ALERT PROGRAM Anchorage Water Tariff Rule 7.1.B.5: The Utility may extend the time for correcting a payment delinquency by an additional fifteen (15) days upon determining that the delinquency is for service to a dwelling occupied by a person who is seriously ill, elderly, handicapped or dependent on life support systems. Special Note: AWWU cannot guarantee uninterrupted service. We request that the customer notify us by telephone immediately in the event of a water outage.
 
 *
 
 *

 *

MEDICAL PROFESSIONAL'S CERTIFICATION:

I certify the following patient is being treated by me for a condition requiring water-dependent life support equipment at the location set forth above.

MEDICAL PROFESSIONAL'S CERTIFICATION: I certify the following patient is being treated by me for a condition requiring water-dependent life support equipment at the location set forth above.

 
 

*** Please notify AWWU if your status changes! ***

Please obtain medical professional’s signature and return completed form to:

 

Life Support Alert Program

AWWU Customer Service

3000 Arctic Blvd.

Anchorage AK  99503-3813

fax (907) 562-0702

  1. To receive a copy of your submission, please fill out your email address below and submit.