CARE Application

Applicant

Full Name

Type/Number

I am a primary residential customer of Bear Valley Electric Service, Inc.

I am a sub-metered tenant of a mobile home park or apartment complex.
Sub-metered tenants are required to apply through their mobile home park or apartment complex owner/manager.

Service Address

Service City, State, Zip

Mailing Address

Mailing City, State, Zip

Phone Numbers

Home Phone

Cell Phone

Work Phone

Household Numbers

Adults in Household

Children in Household

The household's gross annual income or participation in at least one of the listed programs is required.

Gross Annual Income

Programs

Medi-Cal/Medicaid

CalFresh/SNAP

WIC

Medi-Cal for Families

LIHEAP

Supplemental Security Income (SSI)

National School Lunch Program

Agreement

I certify under penalty of perjury that this information is true and correct under the laws of the state of California. I will provide proof of income and I will notify my energy utility of any changes that affect my eligibility. I understand that this information may be shared with my other energy utility, if applicable.

I have read and agree to the above terms

Bear Valley Electric Services, Inc

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