Assistance Application

Assistance Application

Low Income Gas Rate Application

YES! I would like to apply for the Columbia Gas of Massachusetts discounted Low Income Gas Rate. By submitting this form, I authorize the Department of Public Welfare to release information to Columbia Gas in order to:

  1. Determine my eligibility for the discount.
  2. Notify Columbia Gas if my public assistance benefits are discontinued.

I understand that I must notify Columbia Gas if my public assistance benefits are discontinued.


* Denotes Required Fields
Account Number *
Phone Number *   ( ) -
First Name *    
Last Name *    
Email *    
Address *    
City *    
State *  
Zip *    
Programs












** Requires acceptance letter from the certifying agency