Instructions for Completing the LIFSO Agreement

  1. Fill in your name, address and Social Security # in the Spaces provided at the top of the form.
  2. List the Address of the Rental unit you wish to cover under the program in the service address section of the form. You may use a separate sheet of paper if you need more space.
  3. Please list in the space provided in Term #3 the Mailing Address where you would like the bills sent.
  4. At the bottom of the form, please complete the following:
    1. Print your Name
    2. Sign your Name
    3. Circle whether you are the Owner or an Agent
    4. If you are an Agent, please enclose the proper paperwork authorizing you to act on the Owner's behalf.
    5. List your Telephone #
  5. Return the Forms in the self-addressed stamped envelope we provided.