Dealer Rebate Hold Request Form

Use this form to reserve rebate funds for a customer that has ordered an eligible vehicle with a paid deposit, but the vehicle has not yet been delivered. Rebate holds are valid for 12 months from the approval date.

Participating Dealership*
If you do not see your dealership listed here, please contact ev@efficiencymaine.com. If you are purchasing a vehicle directly from a manufacturer, please complete this form.
Dealer Representative*
Dealer Representative Email Address*

This is the email that we will contact for additional information or corrections to documentation, if needed.
Customer Full Name*
Customer Email
Customer Address*
Street Address Address Line 2 City State ZIP Code
Efficiency Maine Rebate Amount*
Vehicle Make and Model*
Required Documents:
A rebate hold cannot be approved until Efficiency Maine receives documentation that the vehicle has been ordered and a deposit has been paid.
Vehicle Order Confirmation*
Max. file size: 32 MB.

Include documentation that a deposit has been paid.
Income Verification Letter from Efficiency Maine*
Max. file size: 32 MB.
Screenshot of Proof of Good Standing (Business/Nonprofit) or Efficiency Maine Pre-Approval Letter (Government)*
Max. file size: 32 MB.

Proof of Good Standing can be found on the Maine Secretary of State's website. Government pre-approval letters must be dated AFTER July 1, 2025.
Attestations*
- I attest that the Required Documents are complete and appear to be valid
*
- I agree to the Program Terms and Conditions and the terms of the Program Manual effective as of the date of the vehicle order
Participating Dealership Authorized Signature*
Please Check

Dealer EV Rebate Hold Request Form

This form is to be completed by a Participating Dealer only.

Participating Dealership*
If you do not see your dealership listed here, please contact ev@efficiencymaine.com. If you are purchasing a vehicle directly from a manufacturer, please complete this form.
Dealer Representative*
Dealer Representative Email Address*

This is the email that we will contact for additional information or corrections to documentation, if needed.
Customer Full Name*
Customer Email
Customer Address*
Street Address Address Line 2 City State ZIP Code
Efficiency Maine Rebate Amount*
Vehicle Make and Model*
Required Documents:
A rebate hold cannot be approved until Efficiency Maine receives documentation that the vehicle has been ordered and a deposit has been paid.
Vehicle Order Confirmation*
Max. file size: 32 MB.

Include documentation that a deposit has been paid.
Income Verification Letter from Efficiency Maine*
Max. file size: 32 MB.
Screenshot of Proof of Good Standing (Business/Nonprofit) or Efficiency Maine Pre-Approval Letter (Government)*
Max. file size: 32 MB.

Proof of Good Standing can be found on the Maine Secretary of State’s website. Government pre-approval letters must be dated AFTER July 1, 2025.
Attestations*
- I attest that the Required Documents are complete and appear to be valid
*
- I agree to the Program Terms and Conditions and the terms of the Program Manual effective as of the date of the vehicle order
Participating Dealership Authorized Signature*
Please Check

Dealer Rebate Hold Request Form

Required Documents:

Dealer EV Rebate Hold Request Form

Required Documents: