Form Seeking Pre-Approval of Qualified Low-Income Maine Resident Status

Efficiency Maine offers enhanced rebates to Qualified Low-Income Maine Residents in the amount of $3,000 for eligible Battery Electric Vehicles (BEVs) and $1,500 for eligible Plug-in Hybrid Electric Vehicles (PHEVs).

To qualify, a resident must be a member of a household, and be domiciled at that household in Maine, that has qualified at any time in the prior 12-month period to receive assistance through the Maine Low Income Home Energy Assistance Program (LIHEAP). The person identified as a Qualified Low-Income Maine Resident in a pre-approval or validation of eligibility from Efficiency Maine must be the same person who is named in the vehicle sales agreement and title application (for purchases) or named in the vehicle lease agreement (for leases) and who subsequently registers the eligible EV.

To request written pre-approval for the enhanced Low-Income EV rebate, complete the form below and submit to Efficiency Maine either electronically or print this form and send by mail to 168 Capitol Street, Augusta, Maine, 04330.

If your eligibility is verified, you will receive a letter of pre-approval from Efficiency Maine within 2-4 weeks. To receive the enhanced low-income EV rebate, participants must provide the letter of pre-approval to the participating car dealer at the time of sale or lease.

Click here for more information about our electric vehicle program.

*Indicates required field

Full Name of Customer*

First

Middle

Last
Full Name for Head of Household*

First

Middle

Last
Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country
Phone*
Email*
Additional Requirements:
- I attest that I am a Maine resident, and a member of a household, domiciled at that household in Maine, that has qualified at any time in the prior 12 month period to receive assistance through the Maine Low Income Home Energy Assistance Program (LIHEAP).*
- I understand that in order to receive the enhanced Low-Income rebate, I must provide the pre-approval letter from Efficiency Maine to a participating car dealer at the time of sale or lease.*
CAPTCHA

_______________________________________________________________________________________
¹ List here the full name, including middle initial, of the customer who is considering purchasing a qualifying electric vehicle.

² List here the full name, including middle initial, of the person who is registered on the Maine LIHEAP list as the head of the household.

Additional Requirements: