Electric Vehicle Direct from Manufacturer Rebate Form

Electric Vehicle Make/Model*
Applicant Name*
Legal Address*

Street Address

Address Line 2

City

State

ZIP Code
Phone*
Email*
Applicant Agreement*
Required Documents*
- I have uploaded signed applicant agreement
- I have uploaded Maine Bureau of Motor Vehicles Form “Application of Certificate of Title”
- I have uploaded copy of retail purchase/lease agreement
- I have uploaded a copy of applicant's driver's license
- I have uploaded proof of local business address (For business applicants only)
Additional Requirements*
- I attest that the required documents are correct
- I attest that the vehicle purchased/leased meets the required MSRP of $50,000 (minus delivery charges)
- I attest that if the vehicle is a plug-in hybrid, it meets the 25-mile all electric minimum range requirement
Applicant Signature*
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