Ohop Mutual Light Company Member Services Operation Round Up Grant Application Senior Citizen Discount Application Font Size: Share & Bookmark Share on FacebookShare on X (Twitter)Share on PinterestShare on LinkedinShare on Email Feedback Print Senior Citizen Discount Application Step 1 of 3 33% Applicant InformationApplicant Name(Required) First Last Co-Applicant/Spouse Information First Last Service Address(Required) Street Address Mailing Address Changed? Update My Mailing Address Mailing Address Street Address City State / Province / Region ZIP / Postal Code Phone(Required)Email Address Qualifying InformationDate of Birth(Required) MM slash DD slash YYYY Household Size(Required) 1 2 3 4 Other Have you received assistance from this program before?(Required) Less than $2,511 Less than $3,408 Less than $4,304 Less than $5,201 Other Monthly income from ALL sources Document VerificationWe are required to verify your income eligibility and proof of identificationProof of Identification & Income(Required) I will provide proof in office I will upload proof here Identification & Proof of Income(Required) Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 20 MB, Max. files: 3. Photo or scanned images of ID, bank statement, pay stub, social security statement, etc.Comments/QuestionsAgreement & Signature(Required) By clicking this box, I electronically sign this application and…I affirm that the facts set forth in it are true and complete. I understand that if I receive the senior discount, any false statements, omissions, or other misrepresentations made by me on this application may result in forfeiture of any prior or future discount amounts.Privacy Policy Consent(Required) By clicking “Submit”, you agree to Ohop Mutual Light Company’s Privacy Policy (linked at bottom of page). You consent to receive phone calls, SMS messages, and e-mails from Ohop Mutual to provide updates on your order and/or for internal program marketing purposes. Message frequency depends on your activity. You may opt-out by texting “STOP”. Message and data rates may apply.CAPTCHAEmailThis field is for validation purposes and should be left unchanged.
Ohop Mutual Light Company Member Services Operation Round Up Grant Application Senior Citizen Discount Application Font Size: Share & Bookmark Share on FacebookShare on X (Twitter)Share on PinterestShare on LinkedinShare on Email Feedback Print
