Electric Vehicle Rebate Dealer Reimbursement Form

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

Use this form to request reimbursement for a rebate already issued to a customer. Rebates must be submitted within 60 days of the vehicle purchase date.

To expedite processing, please upload individual documents to each required field. Efficiency Maine will review, and reserves the right to audit, all information and records submitted with this form. 

“*” indicates required fields