Community Action New Mexico's Energy Advocacy Project

Online Utility Complaint Form
Please complete this form and submit it to CANM by pressing the "Submit" button at the end of this form.

Thank you for your participation!
1. Utility Customer Contact Information
Please provide us with contact information regarding your client. This information will not be shared with the utility companies.
Customer's Name:
Customer's Case No.:
Street Address:
City:
County:
What is the customer's monthly income?:
How many people in customer's household?:
2. Agency Contact Information
Please provide us with your contact information. This information will not be shared with the utility companies.
Agency's Name:
Contact Name:
Email: (required field)
Telephone:
3. Utility Company Information:
Please provide general information regarding the utility company.
Type of Energy:
Utility Company:
Did you or your client speak with a utility company representative? If yes, please provide the representative's contact information
(name, title, phone and/or email):
4. Payment Plans
Please provide us with information regarding "payment plan" problems your client has encountered with a utility company.
Is your client's utility bill past due?
 yes
 no (if no, please move to section 5)
How long has this amount been
past due?:
Was client given the option to enter into a payment plan agreement? If yes, please describe the payment plan and the client's
experience negotiating with the utility company.
5. Deposits  (Proceed to the next section if your client has not encountered problems with a deposit plan.)
Please provide us with information regarding "deposit" problems your client has encountered with a utility company.
Did your client have to pay a deposit?:
 yes
 no (if no, please move to section 6)
What was the deposit amount?:
Did your client have difficulty paying
the deposit? If yes, please explain.
6. Moratoritum  (Proceed to the next section if your client has not encountered problems relating to the moratorium.)
Please provide us with information regarding "moratorium" problems your client has encountered with a utility company.
Is client a LIHEAP recipient or LIHEAP eligible?
 yes
 no
 I'm not sure.
Click here to view the new LIHEAP rules, especially Rule 8.150.610.10.
Did the utility company turn off the customer's utilities during the moratorium? If yes, please explain.
Did the customer service rep. ask client if
she/he was a LIHEAP recipient or LIHEAP
eligible?
 yes
 no
If your client's utilities were shut off during a
moratorium, did the utility company offer the
customer a payment plan option?:
 yes
 no
Was your client in arrears prior to the
beginning of the moratorium?:
 yes
 no
If yes, what was the past due amount?:
7. Nature of Complaint
Add additional comments below.