Submit a request

Proof of enrollment must be submitted and reviewed prior to your enrollment in this program being complete.

You may submit any document or card that verifies your enrollment in a local, state, or federal program for which low income status is required (i.e. Medicaid, LIHEAP, SNAP/EBT, WIC, etc.)

Please enter the details of your request. A member of our support staff will respond as soon as possible. Please attach any useful images below.

Add file or drop files here