Low-Income Assistance Program Online Application

Low-Income Assistance Program Application

"*" indicates required fields

Today's Date *

Month

Day

Year

Name (As it appears on your water bill) *

Account # *

Service Address *

Street Address City State ZIP Code

Is this is your primary residence *

Yes

Phone *

Cell Phone

Email (required for approval) *

Enter Email Confirm Email

Check the utility CARE program(s) for which you currently qualify for. (Check all that apply)

Southern California Edison

Southern California Gas Company

Please upload a copy of your most recent utility bill showing enrollment in their CARE program and submit with this application. *

Max. file size: 200 MB.