Senior Discount form

Application for Senior Citizen Discount

I am applying for the senior citizen discount offered by the City of College Park. I understand that this discount exempts me from paying the electric meter base charge of $10 and I will receive a 10% discount on the electric portion of the utility bill.

I further understand that I must meet all of the following criteria as of the date of this application in order to qualify for the discount. I hereby affirm that the following is true:

I am sixty-five (65) years of age or older. (A copy of my driver's license, photo ID or birth certificate is attached

I live at the address referenced below, and the account is currently in my name.

Note: The information provided is subject to audit and verification as deemed necessary by the City of College Park. The applicant agrees to notify the company immediately of any change in the circumstances that make the applicant ineligible for the discount to senior citizens.

Applicant's Name

Address

Street Address Line 2

CityState

ZIP CodeCounty

Customer Signature

Customer Telephone Number

Date of Birth

Date

If you have any questions regarding this document, contact our Customer Service Department at

Please submit application to: Customer Service Department 3667 Main Street College Park, GA 30337

File Upload

Please submit Photo ID/Driver License Here or Birth Certificate