Apply for MadCAP JavaScript Required You must have JavaScript enabled to use this form. Please enable JavaScript and reload the page. If you cannot enable JavaScript, please contact webadmin@cityofmadison.com to provide your information. Customer Information Do you currently get a credit (discount) through MadCAP? * required No, I'm a new applicant Yes, I am re-applying Customer Name * required Customer Number * required This number is listed on the first page of your bill. Account Number * required This number is listed on the first page of your bill. Email * required Phone * required Service Address * required Street Address * required Unit City * required State * required - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle EastArmed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederate States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP Code * required Household Information Number of people in household * required 1 2 3 4 5 6 7 8 or more Proof of eligibility * required Attach documents that show gross annual income for every household member. If you participate in FoodShare, Section 8, or WIC (Women, Infants, and Children), you can provide that documentation instead. If you need to include more than two documents, please send additional files to madcap@cityofmadison.com. Maximum 2 files. 10 MB limit. Allowed types: jpg, jpeg, png, pdf, doc, docx, xls, xlsx. Declaration The information on this application is true and correct.I have read and understand the requirements of MadCAP.I agree to provide proof of income in order to participate.I agree to notify the City if the number of people in my household or my household income changes.I understand that if I receive the credit without qualifying for it, I may be required to pay back the credit I received.I understand that I need to apply and provide my household income documents every year.The City may take legal action against me if I was not truthful or do not follow these rules. Signature * required By typing my name and submitting this form, I agree to these terms. Leave this field blank JavaScript Required You must have JavaScript enabled to use this form. Please enable JavaScript and reload the page. If you cannot enable JavaScript, please contact webadmin@cityofmadison.com to provide your information. Was this page helpful to you? * required Yes No Why or why not? Leave this field blank Payment Center Customer Assistance Program (MadCAP) Expanded Apply for MadCAP U.S. Bank Account
