CALIFORNIA LIHWAP

Interest Form

For more information about the program click here

https://www.csd.ca.gov/waterbill



This form is ONLY for Water and Wastewater systems providing residential services in the State of CA. Please DO NOT submit an entry as an individual. Click the link below to find how to apply for water bill assistance: https://www.csd.ca.gov/Pages/WaterBill.aspx



 

Company Information

 

Please enter your company name.

 
 

Primary Point of Contact Information

 

Please enter the Company Point of Contact's First Name.

 

Please enter the Company Point of Contact's Last Name.

 

Please enter the Company Point of Contact's Position Title.

 

Please enter the Primary Point of Contact Direct Phone Number

 

Please enter the email address where the Company Point of Contact can be reached regarding enrollment in the CA-LIHWAP Program.

 

Please re-enter the email address where the Company Point of Contact can be reached regarding enrollment in the CA-LIHWAP Program.

 
 

Third Party Billing Information

 

If yes, please complete as much of the Billing Company information as possible.