Energy Net Application

Account Name (Name on Trinity PUD Account) *

PUD Account Number *

Physical Address *

Physical Address City *

Physical Address Zip *

Mailing Address *

Mailing Address City *

Mailing Address Zip *

Phone Number *

Number in Household *

Household Gross Monthly Income *

Attach Proof of income

More information

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png pdf.

Attach Proof of income

More information

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png pdf.

Attach Proof of income

More information

Files must be less than 10 MB.
Allowed file types: gif jpg jpeg png pdf.

Email Address

Guidelines

Guidelines:
I attest that the above information is true. I understand that I must verify the above information.
(Ex: Pay Stubs, Social Security/SSI/SDI Benefits Verification, Retirement Statement, etc.). Bank statements are not acceptable proof of gross income.
I acknowledge that Health and Human Services & Trinity PUD will access this information.
Eligibility is based on gross income and family size. Income cannot exceed 150% of federal poverty level.
Applicants must verify income. Applications without proof of income will not be considered. 
Applicants are ranked from lowest to highest income based on family size to determine priority.
The number of persons receiving rate reductions will be determined by Trinity PUD.
Rate reductions will be in effect for 6 months. Applicants must reapply every 6 months.
Reapplication does not guarantee renewal.

Electronic Signature (I understand that typing my first and last name in this field constitutes a legal signature confirming that I acknowledge and agree to the above guidelines.) *

Energy Net Application

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