Application for Permanently Disabled Rate Discount

  1. Applicant must be a member of Peninsula Light Company with an established account in his/her name during the previous six months.

  2. Applicant must complete the income worksheet below.

  3. Applicant must provide proof of disability (letter from doctor or Award letter from Social Security Administration).

  4. Applicant must reapply annually to ensure they continue to meet the program criteria.

  5. Applicant must be a permanent, year-round resident in Peninsula Light Company's service territory, as opposed to a seasonal, part-time, or vacation resident. To qualify as a permanent resident, the applicant must reside at the service address for a minimum of 300 days per year and receive mail locally all year.

  6. Only the applicant's primary meter will qualify for the discount. Pump services and rental houses shown in the applicant's name do not qualify.
Fields marked with a red asterisk * are required.
*Phone Number:
Contact Number:
*PLC Account Number:
*Social Security Number:
*Date of Birth:    (MM/DD/YYYY)
*Email Address:
Co-applicant Name:
Social Security Number:
Date of Birth:    (MM/DD/YYYY)
Contact Number:

Income Worksheet
Annual Income must include all individuals who live at the residence.
*Number in Household:
*Total Monthly Gross Income $:
*Deduction of Health Care Premiums $:
*Total Adjusted Monthly Income $:

The applicants MUST submit copies of the following:

1. Social Security Card
3. Income verification for the past three (3) months
4. Proof of disability
5. Proof of Health Care Premiums Paid

NOTE: Instructions for submitting additional information can be found at the bottom of this application.

Social Security Card
We must have a copy of the Social Security card or other official document showing the social security number (not hand printed) for ALL individuals who live within the household.

Income Verification
Verification of ALL income received over the past three months is required for all members in the household that are 18 years of age and older. (Copies of retirement statements, social security payments, medical coupons, or any source of income received over the previous three months.) For example, if you are applying during the month of December, verification of income is needed for September, October, and November)

Proof of Disability
Documentation from either your doctor or the Social Security Administration stating you are permanently disabled.

Proof of Health Care Premiums Paid
Examples may be paid receipt from insurance provider, cleared check, bank statement, or policy information.

I swear, under the penalties of either civil or criminal perjury, that I have READ, UNDERSTAND, AND MEET ALL OF THE ABOVE CRITERIA. I understand that if at any future date I no longer meet the criteria, it is my obligation to let Peninsula Light Company know. I consent and agree that Peninsula Light Company may verify and confirm the above if deemed necessary. The Social Security Administration and the Internal Revenue Service are authorized to release any income information from their files.

Click here to draw your signature.

Your Signature
With your mouse, draw your signature. Then click Finish.


Instructions for submitting additional documents:

There are five methods available for submitting additional documentation.

Method 1: Electronic File Upload

You can upload an image or PDF using the file upload tool, below.

The file can be up to 10 MB in size and must be one of the following file types: PDF JPG JPEG PNG GIF ZIP.

If you have multiple files, you can combine them into one zip file (using your zip software) and attach the zip file to this application with the file upload tool.

Attach Document:
Method 2: Fax

Fax copies of pictures and paper documents to the fax number below.

Method 3: Electronic Mail

After submitting this online application, you will receive a confirmation email. By replying to this email you can submit electronic copies of scanned images and PDFs by attaching them. Use the personalized subject provided to ensure your documents get delivered to the right place.

Method 4: Online Upload Tool

After you submit the online application, you can provide additional materials by using our online document upload tool. You will receive more information about the upload tool after the application is submitted.

Method 5: Postal Mail

Mail copies of pictures and paper documents to the address below.

Peninsula Light Company
13315 Goodnough Dr NW
Gig Harbor, WA 98332

Phone: (253) 857-5950
Fax: (253) 857-1558

If you have any questions, please contact our Customer Service Department at (253) 857-5950

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