Click on the PDF Application button below to fill out the the sliding fee application online. Once you have completed the application please mail your completed application and proof of income to the following address for review.
If you prefer you can also fax your application and proof of income to (209) 754-6274, Attn: Billing.
If you need any assistance or have any questions regarding this application, please contact our billing department during normal business hours at:
(209) 754-6240 or (866) 894-1902