Southern California Edison'S Income-Qualifying Rate Programs - Southern California Edison Care/fera Page 2


Source Code (Edison Use Only)
Southern California Edison’s Income-Qualifying Rate Programs
Information and Application for Sub-metered Tenants
Entire application must be completed and signed. Application effective as of June 1, 2007.
I certify:
I understand I must notify SCE and my owner or
I do not receive my electric bill from Southern
manager if I move or exceed the income
California Edison Company (SCE).
I am applying for a rate discount for my permanent
I understand the owner/manager will receive
primary residence.
I understand that I will receive the discount from my
renewal information and I will be asked to renew
owner or manager beginning with the first regular
my application each year.
I am not claimed on another person’s income tax
billing after SCE notifies my owner/manager that
my completed application has been processed.
I understand the definition of “gross (before taxes)
My owner or manager completed the Property
Owner/Manager section of this application.
household income” is all money and noncash
I understand SCE has the right to verify my
benefits, available for living expenses, from all
household’s income. Proof required may include
sources, both taxable and nontaxable, before
such items as tax returns, paycheck stubs, or copies
deductions, including expenses, for all people who
live in my home.
of government records.
TENANT — PLEASE PRINT CLEARLY (Favor de Imprimir con Claridad)
Adults (Adultos)
Children (Niños)
Number of persons in my household (Nº de personas en el hogar):
Total combined annual household income (Ingresos totales al año):
See Maximum Household Income chart on other side.
TTY User
I state that the information I have provided in this application is true and correct. I agree to provide proof of income, if
asked. I agree to inform Southern California Edison and my owner or manager if I no longer qualify to receive the
discount. I understand that if I receive the discount without meeting the qualifications for it, I may be required to pay back
the discount I received. I understand Southern California Edison can share my information with other utilities or their
agents to enroll me in their assistance programs.
Tenant Name
Tenant Mailing Address
Apt./Space No.
, CA ZIP Code
Home Telephone (
Daytime Telephone (
Tenant Signature
This section must be completed by the property owner or manager.
Master-Metered Customer Name
Daytime Telephone (
Service Account No.
Meter No.
Property Address
, CA ZIP Code


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