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Central Electric Cooperative, Inc.
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Electric Vehicle Rebate Form
Electric Vehicle Rebate Form
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Electric Vehicle and Charger Rebate Form
Name
*
First
Last
Installation Service Address
*
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Address where you receive electric service and where the vehicle is registered and/or level 2 charger will be installed.
Mailing Address
*
Same as installation address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cabo Verde
Cambodia
Cameroon
Canada
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
CĂ´te d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
TĂ¼rkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ă…land Islands
Phone
*
Email
*
Which rebate are you applying for?
*
Vehicle Registration
240 Volt Outlet
Level 2 Charger
A CEC engineer has reviewed my level 2 charger installation?
*
Yes
No
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.
A CEC engineer has reviewed my 240 Volt outlet installation?
*
Yes
No
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.
Has the level 2 charger been installed?
*
Yes
No
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.
Has the 240 Volt outlet been installed?
*
Yes
No
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.
Brand of Electric Vehicle
*
Model of Electric Vehicle
*
Brand of Charger Installed
*
Model of Charger Installed
*
Where was the level 2 charger purchased?
*
Installer
Retailer
Online
Other
Who installed the charger or outlet?
*
Total installed cost of EV charger or outlet before rebates
*
Please enter a number from
0
to
10000
.
DMV Registration Upload
*
Drop files here or
Select files
Accepted file types: jpg, jpeg, gif, pdf, png, Max. file size: 30 MB, Max. files: 5.
Please upload a copy of your DMV registration for the electric vehicle registered at your service location.
Receipt Upload
*
Drop files here or
Select files
Accepted file types: jpg, jpeg, gif, pdf, png, Max. file size: 30 MB.
Please upload a copy of your receipt or invoice showing the brand, model number, purchase date and price of the qualifying level 2 charger and/or 240 Volt plug.
Equipment Photo Upload
*
Drop files here or
Select files
Accepted file types: jpg, jpeg, gif, pdf, png, Max. file size: 30 MB, Max. files: 5.
Please upload a photo of the installed charger's model and serial nameplate and/or 240 Volt plug.
Installation Checklist
Follow 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:
*
System is installed to manufacturers specifications
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
Electronic Member Signature
Rebate 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. I understand the above and certify that the job is completed and operating at the location indicated.
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 this form.
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.
Type Full Name
*
Consent
*
I agree to the privacy policy in the link below:
CEC Privacy Policy
Name
This field is for validation purposes and should be left unchanged.
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