Complete & submit your application below.
Once application is approved, all payments will be sent to you through our online portal.
First Name
Last Name
Email Address
How much are your current bills at the moment?
Are you able to post for us twice a day?
Which bill would you like help with?
How soon is this bill due?
Have you ever received assistance like this before?
If selected, how would this support impact you right now?
Are you currently managing bills on your own or with support?
We prioritize applicants who are ready to move forward right away. When would you be able to complete the final steps if selected?
To ensure fair distribution of remaining funds, we prioritize applicants who complete the verification steps. Are you prepared to complete them today?
How did you find out about our Replace A Bill program?
If approved, would you like to opt into our Monthly Meals program? You'll receive an extra $100 Uber Eats gift card per month to complete more small fun tasks.