Eagle Mountain City Utility Assistance Application
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
City Account Number
*
Do you own AND live in the property for which you are applying?
*
Yes
No
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How many people live in your household?
*
1 person
2 people
3 people
4 people
5 people
6 people
7 people
8+ people
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Please select your household annual income (1 person)
Less than $22,900
More than $22,900
Please select your household annual income (2 people)
Less than $43,600
More than $43,600
Please select your household annual income (3 people)
Less than $49,050
More than $49,050
Please select your household annual income (4 people)
Less than $54,500
More than $54,500
Please select your household annual income (5 people)
Less than $58,900
More than $58,900
Please select your household annual income (6 people)
Less than $63,250
More than $63,250
Please select your household annual income (7 people)
Less than $67,550
More than $67,550
Please select your household annual income (8+ people)
Less than $86,340
More than $86,340
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Hello! Thank you for your interest in Eagle Mountain City's Utility Assistance Program. Unfortunately, you are ineligible for this service at this time. Please feel free to apply again in the future.
Eagle Mountain City receives federal money for this program and as such, we are bound by the federal government's eligibility standards.
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Please upload a copy of your most recent paystub or tax form for all employed members of your household.
*
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