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Application
Please fill out the below information for your interest in the program. For more information or any questions please contact us at
seri@seriaz.org
.
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* Indicates required question
Name (first and last)
*
Your answer
Home Address (street, city, state, zip code)
*
Your answer
Telephone # (e.g. 520-234-3298)
*
Your answer
Email Address
*
Your answer
Do you own or rent your home?
*
Own
Rent
What is your language preference?:
*
English
Spanish
Other:
Tucson Water Account #
*
Your answer
Is your account in good standing with Tucson Water? (If your account is not in good standing, you cannot participate in the program until the matter is resolved.)
*
Yes
No
Are you interested in the following program? (Check all that apply)
*
Loan
Grant
Required
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