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Electric Vehicle Rebate Application

Date

Member Account Information

First

Last

Account Number

Map Location

Member Type (Must be the home owner to qualify for rebate.)

If Other, please explain:

Contact Information

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Phone Number

Rate Selection

Time of Use Rate (whole home usage including EV charging)

Plug-in Rate (EV charger usage only. Must allow SVE to install sub-meter equipment/Level 2, 240 volt required.)

Participation Agreement

I agree to the terms of the program rebate program.

E-signature for EV rebate program (Sign using your finger or mouse to write your signature.)

Sign above using your finger or mouse to write your signature.

Electric Vehicle Information

One rebate per account.

Select the type of EV and corresponding rebate:

$500 rebate - Battery Electric Vehicle (BEV)

$250 rebate - Plug-in Hybrid (PHEV)

Is your EV purchased (or leased) and registered with DMV at service address above?

Yes

EV Make:

EV Model:

Proof of Purchase

A copy of proof of purchase/invoice and documentation verifying equipment purchase must be included.

One file only.
20 MB limit.
Allowed types: gif, jpg, png, svg, pdf, png, jpeg, .

Home Charging Equipment

Mobile Charging Cord/220-volt outlet

Level 2 Wall-Mounted Charger

Date of Purchase

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