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

Requested By

Relationship

Account Information

SCE Service Account Number * Where do I find this?

Name on Account *

Service Address

Street Number *

Street Name *

Unit

City *

State *

Zip Code *

Mailing Address

Same as Service Address? *

Yes No

Is this a PO Box? *

Yes No

Street Number *

Street Name *

Unit

City *

State *

Zip Code *

Customer Information

Customer First Name *

Customer Last Name *

Email Address *

Primary Phone *

Alternate Phone

Best Time to Contact

Primary Language *

How did you hear about the program? *