Residential Bill Discount Program Application

Enrollment is available to qualifying Foothills Utilities residential customers in Yuma, Arizona. Eligibility is based on your household size and the
average annual gross income for all members of your household 18 years and older combined. Gross income means your income
before taxes. See if you qualify and apply today.

Discounts Available:

Low-Income Households: You can now receive a $6.00 discount on your water bill and $16.00 discount on your waste water bill each month.
Active Duty Military Personnel: If you are currently serving, you are eligible for a $6.00 discount on water services and a $16.00 discount on waste water services each month.

Residential Bill Discount Program Qualification: Household IncomeActive Military Duty Name on Bill Account Number Service Address Phone Number Email Address (Used for confirmation)
By submitting this application, I certify that the information I have provided in this application is true and correct. I acknowledge that I have read and understood the contents of this application.
1. I understand this is an initial application and Foothills Utilities will follow-up with me after formal enrollment with details regarding my discount. 2. I will notify Foothills Utilities when my active duty status changes by submitting a new application online or by calling 928-342-1238. 3. I will notify Foothills Utilities if my average annual household income or the number of people living in my household changes and I become ineligible. 4. I understand I may be required to provide proof of household income and household size if asked. Information will be made available to Foothills Utilities or entities working on behalf of Foothills Utilities to implement this program. 5. I understand this discount will not apply to charges incurred before enrollment, but only new charges after enrollment (enrollment may take up to 30 days). 6. I may have to recertify when transferring services or opening a new account.
Signature:

Date: