B4L Utility and Bill Assistance Application

If you are in need of assistance with utilities and bills, please fill out our form to the best of your ability. A decision will come to your email 1-3 business days after submitting your application.

Name

First Name

Last Name

Phone

(###)

###

####

Current Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Location

Current Housing Status

Employment

Utility or Bill

Current Balance

Minimum Balance Due

Timeframe or Day of Shutoff Date

B4L Utility and Bill Assistance Application

Budz 4 Lyfe

Hours