Customer Information Form – Disaster Support
First Name is required
Last Name is required
Zip is required
Email is required
Email address does not match standard format
Phone Number is required
Contact Information:
Please provide your best contact information in case we need to reach you during the disaster
*
Denotes a required field.
*
First Name
M. Initial
*
Last Name
Suffix
*
Mailing Address
Street
City
State
Zip Code
*
Best contact phone number
(Note: Cell phone number is preferred if you would like to receive text messages)
*
Email Address:
*
Please indicate your contact preference:
Phone
Email
Mail
Text (must provide a Cell Phone Number for Question 3)
SCE Account Information:
Please complete this section to the best of your ability
Same as Contact Information
SCE Account Holder:
*
First Name
M. Initial
*
Last Name
Suffix
Same as Mailing Address
*
Service Account Address (i.e. the address where you receive your SCE electric service)
Street
City
State
Zip Code
Property Disaster Assessment
Address Impacted by the Disaster?
Yes
No
Status of Property at this Address
Total Loss
Partial Loss
No Loss
Property Evacuated due to Disaster?
Yes
No
Please provide date (Month/Date/Year):
Have you Returned to the Property?
Yes
No
Please provide date (Month/Date/Year):
Was your Electric Meter Damaged?
Yes
No
Are you a Residential NEM customer?
Yes
No
Which NEM tariff are you on?
NEM 1.0
NEM 2.0
Do you intend to rebuild your NEM System within 4 years of the date of the disaster?
Yes
No
Please list any additional addresses on your property
Clear Address
Street
City
State
Zip Code
Property Disaster Assessment
Address Impacted by the Disaster?
Yes
No
Status of Property at this Address
Total Loss
Partial Loss
No Loss
Property Evacuated due to Disaster?
Yes
No
Please provide date (Month/Date/Year):
Have you Returned to the Property?
Yes
No
Please provide date (Month/Date/Year):
Was your Electric Meter Damaged?
Yes
No
Are you a Residential NEM customer?
Yes
No
Which NEM tariff are you on?
NEM 1.0
NEM 2.0
Do you intend to rebuild your NEM System within 4 years of the date of the disaster?
Yes
No
Clear Address
Street
City
State
Zip Code
Property Disaster Assessment
Address Impacted by the Disaster?
Yes
No
Status of Property at this Address
Total Loss
Partial Loss
No Loss
Property Evacuated due to Disaster?
Yes
No
Please provide date (Month/Date/Year):
Have you Returned to the Property?
Yes
No
Please provide date (Month/Date/Year):
Was your Electric Meter Damaged?
Yes
No
Are you a Residential NEM customer?
Yes
No
Which NEM tariff are you on?
NEM 1.0
NEM 2.0
Do you intend to rebuild your NEM System within 4 years of the date of the disaster?
Yes
No
Clear Address
Street
City
State
Zip Code
Property Disaster Assessment
Address Impacted by the Disaster?
Yes
No
Status of Property at this Address
Total Loss
Partial Loss
No Loss
Property Evacuated due to Disaster?
Yes
No
Please provide date (Month/Date/Year):
Have you Returned to the Property?
Yes
No
Please provide date (Month/Date/Year):
Was your Electric Meter Damaged?
Yes
No
Are you a Residential NEM customer?
Yes
No
Which NEM tariff are you on?
NEM 1.0
NEM 2.0
Do you intend to rebuild your NEM System within 4 years of the date of the disaster?
Yes
No
Disaster Details:
Please complete this section to the best of your ability
*
What recent disaster were you impacted by?
Hurricane Hilary (Fresno County, Imperial County, Inyo County, Kern County, Los Angeles County, Orange County, Riverside County, San Bernardino County, San Diego County, Tulare County, and Ventura County)
Borel Fire (Kern County)
December 2023 - January 2024 Winter Storms (Ventura County)
January 2024 Winter Storms (Los Angeles County)
February 2024 Winter Storms (Los Angeles County, Orange County, Riverside County, San Bernardino County, Santa Barbara County, Ventura County)
Rancho Palos Verdes Land Movement (Rancho Palos Verdes)
Line Fire (San Bernardino County)
Bridge Fire (Los Angeles County and San Bernardino County)
Airport Fire (Orange County and Riverside County)
Mountain Fire (Ventura County)
Optional: Please feel free to provide any additional details or comments you would like to share with us:
Submit
