Customer Service Form

 
 

Residential:  Affordability Discount Program (ADP) Online Form

Are you 60 years of age or older?  You may qualify for additional savings.

Household Questions

Is this a new application or a renewal?
*
Indicate total monthly gross household income:
*
*
Additional Requirement - The Household / Family...
*
(Must select at least one item above) *

Senior Citizen Late Payment Waiver

Do you qualify for the Senior Citizen Late Payment Waiver? This waiver provides qualified residential customers to have late payment charges waived.
*

Casa Verde

Are you interested in enrolling in the Casa Verde program?
*

Account Information

10-digit number that starts with 300
*
*
*
*
*
*
*
Ex: (210) 555-1234
 

Penalties for Fraud: 

Whoever obtains or attempts to obtain program enrollment for which he or she is not entitled, by means of willful false statements or other fraudulent means, may be considered guilty of a criminal offense and upon conviction may be fined and/or imprisoned.

 

Please read and click each box below:

I certify that the information for the income of all household members 18 years and older is true and correct to the best of my knowledge and belief. I understand that the information will be verified to the extent possible; and that I may be subject to prosecution for providing false or fraudulent information. Please check box below.
*

I have read and acknowledge the general eligibility requirements to participate in the Affordability Discount Program. I understand that submitting this application does not automatically enroll me in the Affordability Discount Program, and that the information I have submitted must be verified and approved prior to enrollment. Please check box below.
*

By submission of this application, I hereby authorize CPS Energy to release all enclosed application information to other non-profit agencies and/or government entities (e.g. Bexar County, City of San Antonio etc) offering programs for the benefit of the resident or the home. (e.g., thermostat, minor repairs, energy and water efficiency, generation, conservation or community support services).

Electronic Signature

*