Check the Box - Sign Up Online!

Sign Up to Contribute Through Your Monthly Bill

Complete our online Check the Box form and Dollar Energy Fund will forward your request to your utility company. This is a great option for those who use online bill pay or no longer receive a paper bill from their utility company. Requests may take 1-3 billing cycles to be applied to your bill.

Please Note: If you are seeking utility assistance, please do not complete this form. Visit our “Need Help” page or contact your utility company directly to learn about assistance programs for which you may qualify.

In order to process a recurring donation through your utility bill, the contact information provided must be that of the household’s utility ratepayer.

Dollar Energy Fund values your trust. Please review our Privacy Policy. The information you send using this form is encrypted for your security.

Personal Information

Title

First Name

Last Name

Phone Number

Address

City

State

Zip Code

Check the Box Information

Utility Company

Account Number

Check the Box Amount

Every Dollar Makes a Difference

Your contribution, no matter how big or small, can make an extraordinary impact by ensuring local, limited-income families maintain or restore safe utility service.