COtual water form : Utility Assistance & Energy Conservation : Programs : Community Action

City of Tualatin Water Assistance

If you believe you are eligible for this program please fill out the form below and attach any necessary documents.

Name as it appears on your bill

Address as it appears on your bill

City, state and Zip

Mailing address if different

Email Address

Number of people that live in your household

Please provide full name and birthdates for all living in home.

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I am a customer of City of Tualatin water

Customer Number?

Your customer number can be found on the top right corner of the front page of your utility bill

Phone Number

Are you fleeing Domestic Violence and need your address kept confidential?

Please upload any documents that show you are currently enrolled in one of the programs above or income verification for everyone in your household for the last 60 days showing you meet income guidelines

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Community Action is required by law to maintain the privacy of our participants’ protected personal information. For more information about our privacy practices:

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