• Income Qualified Senior or Disabled Member Discount

    Discount Application
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Format: (000) 000-0000.
  • Preferred Contact Method*
  • Image field 48
  • Your application will not be considered complete until our department has received your supporting documents. Please attest that supporting documents have been sent to verify@bentonrea.org
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  • I, the undersigned, hereby certify that the information provided by me above, and any additional associated Power to Care Bill Assistance documents submitted by me, are complete and accurate to the best of my knowledge.   *   

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Should be Empty: