EV Charger Rebate

Vehicle type*
Have you enrolled in our Electric Vehicle Time-of-Day or Electric Vehicle Subscription program? (Note: Connexus Energy meter technician inspection and meter installation must be completed to qualify.)*

YesNo
Member information
Name on account*

First NameLast Name
Connexus account number
Primary phone number*
Secondary phone number
Please enter a valid phone number.
Primary email address*
Installation address*

Street Address

Street Address Line 2

CityState

Zip Code
Member type
Electric vehicle information
Make*
Model*
Year*
Battery range*
Purchase date

MonthDayYear
Date
Charger information
Charger manufacturer*
Charger kW*
Circuit AMPS*
Date of installation*

MonthDayYear
Date
Total project cost (must match provided invoices/receipts)*
Did you self-install or did a contractor complete installation?*

Self-installContractor
Contractor information
Company
Contact name
Email address
example@example.com
Phone number
Please enter a valid phone number.
Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Attach all itemized invoices/receipts associated with the purchase/installation of your project (including but not limited to, electrician invoices, level 2 charger invoice, etc.), proof of Electric Vehicle purchase, and proof of electrical inspection.

Cancelof
Member hereby certifies that 1) the member is solely responsible for the accuracy of the application information; 2) all installation is complete and operational prior to submitting this application; 3) acknowledges that nothing contained in the application shall impose any liability on Connexus Energy for any work performed or information presented by the member’s engineer, contractor, or vendor; and 4) Connexus reserves the right to verify performed work.
Signature*

Clear
Please verify that you are human*
By providing your phone number(s), including any mobile number, you authorize Connexus Energy and its agents to contact you regarding your account using any means, including automatic telephone dialing systems, prerecorded voice messages, text messages, or other forms of communication. You understand that message and data rates may apply. Your consent is not a condition of receiving service. If your number changes, you agree to promptly notify Connexus Energy.
Should be Empty:

Member information

Electric vehicle information

Charger information

Contractor information