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