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Financial Hardship Form

* indicates required fields




Please enter a valid value in the format of 12345-67890

Please enter a valid value in the format of 12345-67890






Please enter a valid value in the format of 999-999-9999

Please enter a valid value in the format of 999-999-9999




Please list ALL people living in the household and their date of birth (including children). For each person in the household, list their income source(s), income amount, and how often that amount is received.

Household Person Information

Name Date of Birth Income Sources Income Amount This Amount is Received
MM/DD/YYYY
Please enter the amount with a decimal point (i.e. 100.00)
MM/DD/YYYY
Please enter the amount with a decimal point (i.e. 100.00)
MM/DD/YYYY
Please enter the amount with a decimal point (i.e. 100.00)
MM/DD/YYYY
Please enter the amount with a decimal point (i.e. 100.00)
MM/DD/YYYY
Please enter the amount with a decimal point (i.e. 100.00)
MM/DD/YYYY
Please enter the amount with a decimal point (i.e. 100.00)
MM/DD/YYYY
Please enter the amount with a decimal point (i.e. 100.00)
MM/DD/YYYY
Please enter the amount with a decimal point (i.e. 100.00)
MM/DD/YYYY
Please enter the amount with a decimal point (i.e. 100.00)
MM/DD/YYYY
Please enter the amount with a decimal point (i.e. 100.00)
Name Date of Birth Income Sources Income Amount This Amount is Received
MM/DD/YYYY
Please enter the amount with a decimal point (i.e. 100.00)


National Grid offers Discount Rates to customers who receive certain public benefits. Call the Customer Service number on your bill to learn more and to ask for an application.

This application is for customers based in Massachusetts. To learn more about Special Protections in your area, please visit the Long Island Special Protections website.

This application is for customers based in Massachusetts. To learn more about Special Protections in your area, please visit the New York City Special Protections website.

This application is for customers based in Massachusetts. To learn more about Special Protections in your area, please visit the Upstate New York Special Protections website.