Customer Assistance Program (CAP) Application

Thank you for applying to the Customer Assistance Program.

Please note prior to completing an application:

  • Prior to starting the CAP online application, please review the requirements by clicking on this link to ensure the application is correctly completed.
  • After reviewing the online CAP Application form, please have the necessary document information readily available.
  • Use a PC or Mac with Chrome browser or Android devices. iOS devices cannot be used to create and upload a file.
  • Only one file per application is allowed (PDF or MS Word document).
  • Files from PC, Macs or Android using Chrome browser are allowed.
  • Once your application is submitted, you will receive a confirmation email. The email will not provide a copy of your application. Please keep a copy of your submitted documents for your records.
  • Please allow 30 days for processing. You will receive a response in the U.S. mail regarding your CAP application status.

If you have questions, please email or call 866-403-2683. Customer Service hours: 8 a.m. to 4:30 p.m., Monday through Friday.

Customer Information

Household and Income Information

Household Income Information
You must report all income sources for each person who resides in this household. Check all income sources below that household members receive and attach documentation for each income source.
Household Income Sources *
Upload Instructions
Disability or Workers' Compensation payments General Assistance, cash and/or other income Gross wages and/or gross profits from self-employment Interests/Dividends from: savings, stocks, bonds, or retirement accounts Insurance or legal settlements Pensions Rental or royalty income Scholarships, grants or other aid for living expenses Social Security Spousal or Child Support State Supplementary Payment (SSP) or Supplemental Security Income (SSI) Unemployment benefits
Declaration and Application Checklist
Declaration and Application Checklist (Please read, check the three boxes to acknowledge the terms) *
How did you hear about EBMUD's Customer Assistance Program?
To review your application, click Back to Household and Income Information. Otherwise, click the Submit button to submit application.