West Virginia Public Service Commission
ELECTRONIC REQUEST FOR ASSISTANCE FORM

DO NOT USE THIS FORM FOR TERMINATIONS OR EMERGENCIES - CALL 1-800-642-8544

Important Instructions: Please Note that by submitting a Request, you are allowing us to contact the company(ies) noted, AND you are agreeing to allow the company(ies) to share with us information about your account. If you do not want us to have this information, PLEASE DO NOT SUBMIT THIS REQUEST.

For utility requests, you MUST contact the utility FIRST.

Fields with an * are Required Fields and need to be filled out or answered appropriately.


Section 1: Contact OR Customer Information - ALL requests answer this section.

  1. *
  2. *
  3. *
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  5. *
  6. *
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  8. *
  9. *
  10. *
  11. If no phone, please fill out Section 2 BELOW.
  12. **Please include area code. Example: xxx-xxx-xxxx ** *

Section 2: Contact Person, if OTHER than ABOVE

  1. **Please include area code. Example: xxx-xxx-xxxx **

Section 3: Utility Information

  1. Is this request associated with a specific account? *
  2. You MUST answer the questions BELOW, if the above answer is YES OR if the UTILITY TYPE is Electric, Gas, Sewer, Water, Telephone or Cable.
  3. *
  4. *
  5. *
  6. *
  7. *
  8. *

Section 4: Briefly Describe Situation and Remedy Being Requested - ALL requests answer this section. *