West Coast Gas Co., Inc. 9203 Beatty Drive
Sacramento, CA 95826-9702
(916) 364-4100

Committed to Safety and Service

Customer Information

Number Of Persons Permanently Residing In Household:

+
=

I Hereby Certify:

  • My name is on the WCG bill
  • I am not claimed on another person's income tax return
  • I will renew my application when requested by WCG
  • I will notify WCG if I no longer qualify for this rate
  • I understand that WCG reserves the right to verify my household's income

There Are 2 Ways To Qualify!

1. Public Assistance Program Eligibility

If you or someone in your household participates in any of the following programs, please select the programs below:








OR

2. Income Eligibility

Maximum Gross Yearly Household Income Guidelines (Effective as of June 1, 2024)

Household Size 1-2 3 4 5 6 7 8
Gross Yearly Income $40,880 $51,640 $62,400 $73,160 $83,920 $94,680 $105,440

For each additional person, add $10,760

Gross (before taxes) Yearly Income, is income from ALL sources for ALL persons residing in the household.

Please check ( √ ) ALL sources of your household income











Total Combined Gross Yearly Household Income:

$

Example: Current monthly income x 12 months = yearly household income

Declaration

I state that the information I have provided in this application is true and correct. I understand that I may be requested to provide updated documentation of eligibility at any time and agree to do so regardless of how I initially became eligible for the discount. I agree to inform West Coast Gas Company Inc. if I no longer qualify to receive the discount. I understand that if I receive the discount without qualifying for it, I may be required to pay back the discount I received.