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Efficiency Maine EV Rebate Reimbursement Form

Dealer Pathway (for EVs purchased from a dealer)

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

All fields must be completed and all documentation must be valid. Efficiency Maine will review, and reserves the right to audit, all information and records submitted with this form. 

  • If you do not see your dealership listed here, please contact ev@efficiencymaine.com. If you purchased or leased a vehicle directly from a manufacturer, please complete this form.






  • Please select battery electric vehicle (BEV) or plug-in hybrid electric vehicle (PHEV)
  • Required Documents:

    Please attach to this form copies of the following required documents. The Dealership's reimbursement cannot be made until all documents on this list are completed and filed at Efficiency Maine. Documents are ordered for reference and are available here.
  • Please provide a screenshot of the entity’s “Status” from the Maine Secretary of State’s website (https://icrs.informe.org/nei-sos-icrs/ICRS).
  • Additional Requirements:

    Please review the following checklist to ensure that each critical rule in the EV Program Manual has been followed with the purchase or lease for which your dealership is seeking reimbursement.




  • (As indicated in the Participating Dealership Agreement)







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