Electric Vehicle Rebate Application

EV Rebate Application

Section A: MEMBER INFORMATION
Member Name (as it appears on NHEC bill) * Required
NHEC Account Number * Required
Mailing Address * Required
Street Address Address Line 2 City State ZIP Code
Physical Address * Required
Street Address Address Line 2 City State ZIP Code
Daytime Phone # * Required
Email * Required
Section B: Electric Vehicle Information
My Electric Vehicle was
Electric Vehicle Classification
Vehicle Make
Vehicle Model
Vehicle Year
VIN of purchased or leased Electric Vehicle * Required
Name of Dealership or Seller of Electric Vehicle
Dealership or Seller Address Information * Required
Street Address Address Line 2 City State ZIP Code
Did you purchase a Level 2 Charger?
Please upload copy of the New Hampshire Registration Certificate * Required
Please upload copy of final sales contract or lease agreement * Required
Section C: Signatures
I have read and understood all materials, including the Terms and Conditions * Required
- Yes
Download Eligible Equipment & Incentives, and read Terms and Conditions
Member Signature * Required
Date - must be mm/dd/yyyy format * Required
Date Format: MM slash DD slash YYYY
Comments
This field is for validation purposes and should be left unchanged.

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Section A: MEMBER INFORMATION