1. Section
  3. PG&E account number*
  5. Electric meter number
  6. Account holder's first name*
  7. Account holder's last name*
  8. Serivce address (100 Main St)*
  9. Address 2 (Apt, Suite, etc.)
  10. City*
  11. ZIP code*
  12. State
  13. Email (john@smith.com)*
  14. Confirm email*
  15. Phone (4151234567)
  16. Extension
  18. Are you enrolled in PG&E’s CARE or FERA discount programs?*

  19. Do you participate in any of the Public Assistance Programs listed below?*

    • Low Income Home Energy/Assistance Program (LiHEAP)
    • Women, Infants, and Children (WIC)
    • CalFresh/SNAP (Food Stamps)
    • CalWORKS (TANF) or Tribal TANF
    • Head Start Income Eligible (Tribal Only)
    • Supplemental Security Income (SSI)
    • Medi-Cal for Healthy Families (Healthy Families A & B)
    • National School Lunch Program
    • Medicaid/Medi-Cal (under age 65)
    • Medicaid/Medi-Cal (over age 65)
  20. Number of adults in your household*
  21. Number of children (under the age of 18) in your household*
  22. Estimated annual household income*
  23. Sponsor code, if applicable
  25. Signature*
  26. Signature*
  27. Please verify that you are not a robot. Select the check box and click submit to verify.*
  28. Submit

Customer information

Content

You will find this on the first page of your PG&E bill. Please enter only the first 10 digits.

(First 10 digits only, ignore any dashes. E.g., 1234567891)

Eligibility

Signature*