Senior Discount Program Application
Name: Account #:
Address: City/Zip:
Home Phone #: E-mail address:
Are you the head-of-household? YES NO Are you 65 years of age or older? YES NO
What is your date of birth? Can you provide proof of age? YES NO
Does your total family income Are you claimed as a dependent
exceed $30,000 annually? YES NO on another person’s tax return? YES NO
Verication of eligibility may be required
Please enroll me in: Senior Discount
I certify under penalty of perjury that the above information is true and correct. If my status changes, it is my responsibility to modify EDCO.
Annual renewal may be required.
Signature:__________________________________________________________________Date:________________________________
Please return application to: EDCO • 6670 Federal Blvd. • Lemon Grove, CA 91945.
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