You may download the Senior Disabled Discount Application Form (PDF) If you are a senior citizen or a disabled citizen and your total household income for the year falls at or below $34,825, you may be eligible for a discount on your monthly electric service at your primary residence. To apply please fill out this form, attach the required income verification for all people living in your household and return it to the Customer Service Department. Please find discount tiers and acceptable forms of income below: Total Household Income Guidelines for 2024 Income Level Percent Discount 0 to $18,825 35% $18,826 to $22,825 30% $22,826 to $26,825 25% $26,826 to $30,825 20% $30,826 to $34,825 10% $34,826 and up Discount does not apply Acceptable income verification: 2023 income tax return If you do not file taxes: Current SSI award letter (total benefits paid prior to deductions) or Current L&I pension verification letterPlease Complete All Required Fields & QuestionsName(Required) First Last PUD Account Number(Required) Service Address(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Mailing Address(Required) Same as Service Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Email Phone(Required)Social Security Number(Required) Are You At Least 62 Years of Age?(Required) Yes No Are You Disabled and Receiving SSI and/or L&I?(Required) Yes No Do You Live in Federally Subsidized Housing?(Required) Yes No Is the Service Address You Listed Your Primary Residence?(Required) Yes No Do You Receive an Electric Bill From Grays Harbor PUD in Your Name?(Required) Yes No What is the Total Number of People Living in Your Household?(Required) Number of adults 18 or older(Required) Number of children below age 18(Required) What is the Combined Income for All People In Your Household?(Required)HiddenPlease Attach Income Verification (OLD)Accepted file types: jpg, png, jpeg, Max. file size: 300 MB.Please Attach Income Verification(Required)*Bank statements are not an acceptable form of social security verification. Drop files here or Select files Accepted file types: jpg, png, jpeg, Max. file size: 300 MB. Consent(Required) By signing below I swear under penalties of either civil or criminal perjury that all of the above statements and those marked are true. I consent and agree that Grays Harbor PUD may verify and confirm the above information if deemed necessary. The Social Security Administration and the Internal Revenue Service are authorized to release my income information from their files.Member Electronic Signature (Full Name)(Required) EmailThis field is for validation purposes and should be left unchanged.
