Simply fill out the form below to make either an ongoing or one-time contribution to Heat Care. All donations are tax deductible. If you would prefer to mail this form, please download and print the Heat Care form.

* Denotes a Required Field

Account Information

* Name:

Required: Please enter your name

* Service Address:

Required: Please enter your address

* City:

Required: Please enter your city

* State:

Required: Please enter your state

* ZIP code:

Required: Please enter your ZIP Code

ZIP Code must be numbers only

* PSNC Energy Account Number
(last 4 digits only):

Required: Please enter your acct number
Acct. # must be numbers only

* Daytime Phone number:

Required: Please enter your daytime phone number

Alternate Phone number:

* E-mail address:

Required: Please enter your e-mail address

This email address does not appear to be valid

* Confirm E-mail address:

The Confirm E-mail address and E-mail address do not match

* Contribution Amount: $ (please specify)
Required: Please enter the amount you wish to contribute

Please correct your contribution amount

* I am making the following type of contribution:

Required: Please specify the type of contribution you wish to make

Ongoing contribution (the contribution amount will be applied to my next bill and will be added to future bills)

One-time contribution (the contribution amount will be applied to my next bill only)

* Name:	Required: Please enter your name
* Service Address:	Required: Please enter your address
* City:	Required: Please enter your city
* State:	Required: Please enter your state
* ZIP code:	Required: Please enter your ZIP Code ZIP Code must be numbers only
* PSNC Energy Account Number (last 4 digits only):	Required: Please enter your acct number Acct. # must be numbers only
* Daytime Phone number:	Required: Please enter your daytime phone number
Alternate Phone number:
* E-mail address:	Required: Please enter your e-mail address This email address does not appear to be valid
* Confirm E-mail address:	The Confirm E-mail address and E-mail address do not match
* Contribution Amount:	$ (please specify) Required: Please enter the amount you wish to contribute Please correct your contribution amount
* I am making the following type of contribution: Required: Please specify the type of contribution you wish to make Ongoing contribution (the contribution amount will be applied to my next bill and will be added to future bills) One-time contribution (the contribution amount will be applied to my next bill only)