Customer Assistance Programs Online Form

Thank you for your interest in UGI’s Customer Assistance Programs. To help us determine which programs you may be eligible for, identify your household weekly gross (before taxes) income level in the chart below and complete the form.

	Number of People Living in Your Household
Weekly Income Level	1	2	3	4	5	6	7	8
Level 1	$421or Less	$569 or Less	$717 or Less	$865 or Less	$1,014 or Less	$1,162 or Less	$1,310 or Less	$1,458 or Less
Level 2	$421 – $561	$569 – $758	$717 – $956	$865 – $1,154	$1,014 – $1,352	$1,162 – $1,549	$1,310 – $1,747	$1,458 – $1,945
Level 3	$561or More	$758 or More	$956 or More	$1,154 or More	$1,352 or More	$1,549 or More	$1,747 or More	$1,945 or More

Please allow 15 business days for UGI to respond to your online inquiry.

Name on UGI Account

Last 4 Digits of UGI Account Number

Service Address

Service Address City, State, Zip Code

Number of People in Household

Please select your household income based on chart above

Level 1 Level 2 Level 3

Is there a particular program you are interested in? Select all that apply.

CAP LIURP Operation Share LIHEAP

What to Expect After Submitting this Form:

UGI will review your form submission.
If your account is eligible to take advantage of assistance programs, UGI will send you the appropriate paperwork required for enrollment into the program.
You will be notified by UGI or the Community-Based Organization if your application is approved.
Please allow two to four weeks for the above process.

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Customer Assistance Programs Online Form

What to Expect After Submitting this Form: