Commercial and Multi-Family EV Charger Rebate LinkedInThis field is for validation purposes and should be left unchanged.Member Account Name(Required)Account or Meter Number(Required)Installation Service Address(Required)Address where you receive electric service and where the charger is installed. Street Address Address Line 2 City ZIP Code Rebate Mailing Address(Required) Same as installation address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Phone(Required)Email(Required) Which rebate are you applying for?(Required) Level 2 Charger (240 V) Level 3 Charger (480 V) 240 Volt Outlet Has a CEC engineer reviewed my charger or outlet installation?(Required)Prior to the installation of any new equipment, a CEC engineer must review the existing system infrastructure to ensure it is properly sized to accommodate your new equipment. If you select no, please complete and submit the form. After a CEC Engineer has reviewed the information, we will contact you with further instructions. If you select yes, please complete and submit the form including the required uploads. Yes No Has the charger or outlet been installed?(Required)If your system has not been reviewed by a CEC engineer, but is already installed, please complete the additional sections of the form including the uploads. After a CEC Engineer has reviewed the information, we will contact you with further if necessary. Yes No Brand of Charger Installed(Required)Model of Charger Installed(Required)How Many Charging Ports or Outlets Were Installed(Required)Please enter a number from 0 to 10000.How Many Charging Ports or Outlets Will Be Installed(Required)Please enter a number from 0 to 10000.Invoice Upload(Required)Please upload a copy of your invoice showing the brand, model number, purchase date and price of the charger and/or outlet installation. Drop files here or Select files Max. file size: 100 MB. Equipment Photo Upload(Required) Drop files here or Select files Max. file size: 100 MB. Federal W9 Upload(Required)Please upload a copy of your federal W9 for your business in order to receive payment. Drop files here or Select files Max. file size: 100 MB. Installation ChecklistFollow the manufacturer's installation instructions exactly. Failure to do so will result in disqualification from the program, may void the manufacturer's warranty and may result in lower than expected system performance.I certify that the following installation items are complete and accurate:(Required) The EV charger must be installed on a non-residential property. Installation complies with National Electric Code along with local, county and state requirements Charger or outlet is new, not resold, rebuilt or received from warranty insurance claims or won as a prize System is installed to manufacturers specifications. Electronic Member SignatureRebate amounts and program requirements are subject to change or be discontinued at any time by Central Electric Cooperative (CEC). CEC disclaims any warranty, whether expressed or implied, regarding the equipment listed above and for materials or labor associated with installation, maintenance, repair, or any energy savings associated with use. All locations and jobs are subject to inspection. Electricity usage, job information and all application data may be analyzed or shared to partnering third parties by participating in energy efficiency programs by CEC. Equipment and installation of the job must meet all program criteria to qualify for rebates. Consent(Required)By checking this box and typing my name, I certify that all information on this form is true and correct. I also agree that the checkbox and my name typed below are to be used as my electronic signature. I understand that I can be held liable if I provide false or misleading information. I certify the above information is true and correct and I am the person submitting the form(Required)Type Full NameConsent(Required) I agree to the CEC Privacy Policy.
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