Southern California Edison

Energy Savings Assistance Program Enrollment Form

Please complete the information requested below. Fields marked with a red asterisk * are required in order to submit your enrollment form. Once you have completed the form, review it carefully before submitting.

Requestor Information

Account Information

    Where do I find this?

Service Address

Mailing Address

Same as Service Address? *
 
Is this a PO Box? *
 

Customer Information

Income Pre-Qualification Information

Public Assistance Program *














Are any household members permanently disabled?