BUFFALO WATER

Residential Affordable Water Program

City of Buffalo residential accounts only | 2026 Application

Instructions: Complete all required fields, select one household size and income range, then sign and submit. Income will be reviewed and may require supporting documentation before benefits are applied.

1. Applicant and Account Information

Account number *

Applicant type *

Owner

Renter

Email address

Applicant last name *

Applicant first name *

Middle initial

Home phone *

Name on account - last name *

Name on account - first name *

Initial

Cell phone *

Service street number *

Street name *

Apt/Unit

City

State

ZIP code *

Preferred contact method *

Phone

Mail

2. Eligibility Information

Select one household size and one income range based on total annual household income before taxes.

Family size	Very Low Income	Low Income
1	$0 - $35,550	$35,551 - $56,850
2	$0 - $40,600	$40,601 - $65,000
3	$0 - $45,700	$45,701 - $73,100
4	$0 - $50,750	$50,751 - $81,200
5	$0 - $54,850	$54,851 - $87,700
6	$0 - $58,900	$58,901 - $94,200
7	$0 - $62,950	$62,951 - $100,700
8	$0 - $67,000	$67,001 - $107,200

Applicant acknowledgments

I certify that the household size and income range selected are accurate. *

I understand additional documentation may be requested to verify eligibility. *

3. Applicant Certification and Signature

I hereby certify, under penalty of perjury, that all information provided in this application is true and complete. I understand that if I receive financial credits from the Buffalo Water Board, I must inform the Buffalo Water Board within ten (10) days of any change in household financial status that differs from the information in this application. The Buffalo Water Board may request additional financial information at any time to support or confirm this application. If the Buffalo Water Board determines that the information provided is incomplete, false, or misleading, or if I do not cooperate with requests for additional information, the Buffalo Water Board may revoke and reverse any financial credits applied, seek restitution for credits provided, and otherwise exercise any rights allowed by law.

I Agree *

Date:

August 27, 2026

* By agreeing here, I provide my electronic signature for the submission.