SERVICE AGREEMENT
THIS AGREEMENT BETWEEN SEMINOLE NATION OF OKLAHOMA FAMILY SERVICES LIHEAP
AND_______________________________________________
ENERGY SUPPLIER
1. ALLOW FOR A RATE DISCOUNT OF_________ON COST OF SERVICE
TO RECIPIENTS OF LIHEAP ASSISTANCE FOR 1997 FISCAL YEAR;
2. AND/OR, WEATHERIZATION DISCOUNT OF___________ON COST OF
SERVICE TO RECIPIENTS OF LIHEAP ASSISTANCE FOR 1997 FISCAL YEAR;
3. AND/OR, ARREARAGE FORGIVENESS ON COST OF SERVICE TO
RECIPIENTS OF LIHEAP ASSISTANCE FOR 1997 FISCAL YEAR;
______YES ______NO
4. AND/OR, FEE WAIVER ON COST OF SERVICE TO RECIPIENTS OF
LIHEAP ASSISTANCE FOR 1997 FISCAL YEAR
______YES ______NO
THIS AGREEMENT IS EFFECTIVE AS OF______________________________.
Month Date Year
________________________________
__________________________________
SEMINOLE NATION OF OKLAHOMA AUTHORIZED VENDOR
REPRESENTATIVE
FAMILY SERVICES LIHEAP
COORDINATOR
LIHEAP FY 1997