Customer Protections Form

Is your service currently on or has it been shut off for non-payment?

My service is currently onMy service has been shut off for non-payment

Which account will you be claiming Protections?

ElectricGasBoth Gas and Electric

Electric Account Number

Please enter a valid value in the format of 12345-67890

Gas Account Number

Please enter a valid value in the format of 12345-67890

Account Holder Name

Account Service Address

City

State

Zip Code

Primary Phone Number

Please enter a valid value in the format of 999-999-9999

Alternate Phone Number

Please enter a valid value in the format of 999-999-9999

Customer Email

How would you like to receive updates regarding your protections application status?

EmailUS Mail

Notification Email (updates will be sent to this email address)

Please list ALL people living in the household and their date of birth (including children). For each person in the household, list their income source(s), income amount, and how often that amount is received. (Click Add Additional Person below to list additional people.)

Household Person Information

Name

Date of Birth

MM/DD/YYYY

Income Sources

Income Amount

Please enter the amount with a decimal point (i.e. 100.00)

How often income amount above is received?

WeeklyBi-WeeklyMonthlyYearly

Click to certify information as true

Yes, I certify that the information provided above is complete and true to the best of my knowledge. (National Grid reserves the right to request documents to support this information.)

National Grid offers Discount Rates to customers who receive certain public benefits. Call the Customer Service number on your bill to learn more and to ask for an application.

This application is for customers based in Massachusetts. To learn more about Special Protections in your area, please visit the Long Island Special Protections website.

This application is for customers based in Massachusetts. To learn more about Special Protections in your area, please visit the New York City Special Protections website.

This application is for customers based in Massachusetts. To learn more about Special Protections in your area, please visit the Upstate New York Special Protections website.

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Select Your Region

Massachusetts

New York

Financial Hardship Form

Household Person Information