California Water Guard

Residential Efficiency Program Application

Primary Applicant

Full Name *

Date of Birth *

Email Address *

Primary Phone *

Secondary Phone

Social Security Number

Driver's License Number *

Issue Date *

Expiration Date *

Street Address *

City *

Zip Code *

Residence Type *

Monthly Mortgage/Rent ($)

Time at Residence

Employment Status *

Employer Name

Employer Phone Number

Occupation Title

Gross Monthly Income ($)

Full Name

Date of Birth

Email Address

Primary Phone

Secondary Phone

Social Security Number

Street Address

Zip Code

Residence Type

Monthly Mortgage/Rent ($)

Time at Residence

Employment Status

Employer Name

Occupation Title

Gross Monthly Income ($)

Notes / Water Issues