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Efficiency Maine EV Rebate Dealer Reimbursement Form

For EVs purchased from a Maine Participating Dealer

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

Use this form to request a reimbursement (must be submitted within 60 days of purchase) or a rebate hold (for a vehicle on order that won’t be delivered until a later date).

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. 

“*” indicates required fields

  • 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). Only vehicles with a charging plug are eligible for a rebate.
  • Required Documents:

    Please attach to this form a copy of the Vehicle Order Confirmation. A rebate hold cannot be approved until Efficiency Maine receives an order confirmation showing that the vehicle has been ordered and a deposit has been paid.
  • Max. file size: 32 MB.

  • 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.
  • Max. file size: 32 MB.

  • Max. file size: 32 MB.

  • Max. file size: 32 MB.

  • Max. file size: 32 MB.

  • Max. file size: 32 MB.

  • Max. file size: 32 MB.

  • Max. file size: 32 MB.

  • Max. file size: 32 MB.

  • Max. file size: 32 MB.

    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?MainPage=x).
  • Max. file size: 32 MB.

  • Max. file size: 32 MB.

  • 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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