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Low Income Home Energy Assistance Program Division 10 Service 415 Program 415 Chapters 05 - 65 North Dakota Department of Health and Human Services

The cost of the fuel must be that for a single delivery of fuel only. The vendor may enter the exact amount of the delivery including the cents. He may also add in any normal delivery charges, but not finance charges. Deposits may NOT be included.

If he chooses, the vendor may hold the "Request for Payment" until all customers listed have a bill to be submitted, although most vendors will likely want to submit bills for those customers owing money at least once per month, if not more often. Those customers who do not owe a bill at the time the report is completed may simply be left blank. Their names will appear again on the next updated "Request for Payment."

3. Mailing the Report and Vender Signature Instructions for mailing the "Request for Payment" are printed on the left side at the bottom of the list of names on the last page of the report if the list of approved customers is more than one page long.

The vendor agreement is printed on the right side at the bottom of the list of names on the last page of the report.

The vendor MUST sign and date the "Request for Payment" before it will be processed.