Young child drinking fresh water from a blue cup near a sink

Monthly Income Guidelines

Number of
Persons
in Household		 Total Combined Monthly Income
1$3,123
2$4,228
3$5,333
4$6,438
5$7,543
6$8,648
7$9,753
8$10,858
For each
additional person		 $1,105

Want to Lend a Hand?

If you wish to contribute to the program, you can do so by adding a donation to your monthly New Jersey American Water bill. You can be assured that 100 percent of your donation and our matching funds go directly to qualifying customers. Our company assumes all administrative costs for this program, so that every penny you donate goes directly to this worthwhile cause.

Please complete, detach and return this form with your next New Jersey American Water bill payment. You can also send a donation directly to New Jersey SHARES at:

New Jersey SHARES
1901 North Olden Avenue Extension
Suite 1A
Ewing, NJ 08618

Learn More Online

This program is administered by New Jersey SHARES. For more information, log on to www.njshares.org or visit New Jersey American Water’s website at www.newjerseyamwater.com. Customer Service & Billing, select Low Income Program.

Assist a Family in Need

H2O Help to Others™ Program
Pledge Form

Yes, I would like to assist an individual or family in need.

▢
I would like to make a one-time donation of
$
▢
I would like to donate a regular amount each month. Please add this amount to my monthly water bill:
$25 $10 $5 $1 Other $
Name (please print)
Account Number
Address
City
State Zip
Signature
Date
Please complete, detach and return this form with your next New Jersey American Water bill payment. You can also send a donation directly to New Jersey SHARES at:
New Jersey SHARES
1901 North Olden Avenue Extension
Suite 1A
Ewing, NJ 08618
Please write “H2O Program Donation - NJ” on the memo portion of your check.
For more information, call 1-877-652-9426 (1-877-NJAWH2O).