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ELECTRIC VEHICLE REBATE PROGRAM – LIMITED PROMOTION FOR
BUSINESS FLEETS
FORM #16 – BUSINESS ENTITY PRE-APPROVAL APPLICATION
168 Capitol Street, Suite 1, Augusta, ME 04330 | (866) 376-2463 | efficiencymaine.com
1
6/30/2021
INSTRUCTIONS
1. Complete form (typed if possible) and submit a signed copy by email to ev@efficiencymaine.com.
2. If approved, you will receive a letter from Efficiency Maine stating that you are eligible for enhanced rebates as a business entity.
3. Present the pre-approval letter from Efficiency Maine at the dealership to receive an enhanced rebate.
4. Please notify Efficiency Maine promptly of any changes to the number and type of vehicles that the entity plans to purchase or
lease.
PRIMARY CONTACT/BUSINESS ENTITY INFORMATION
Name of Business
Employer Identification Number (EIN):
Primary Contact Name
Number of vehicles the entity intends to purchase or lease:
Primary Contact Phone
Make
Primary Contact Email
Will the vehicle(s) be replacements for existing
vehicles or adding new vehicles to the fleet?
Replacements __
New vehicles __
Mailing Address:
Physical Address (if different):
City
State
ZIP
City
State
ZIP
SIGNATURE OF AUTHORIZED REPRESENTATIVE (Required)
This form certifies that the entity identified herein is a business entity in good standing, authorized to do business in the State of Maine,
and having an office in the State of Maine. We acknowledge that execution and delivery of this certification is a condition for pre-approval
by Efficiency Maine for eligibility to receive enhanced rebate amounts in the EV Accelerator Program.
Executed as of the date noted below by its duly authorized officer.
Full Name:
Title:
Signature of duly authorized officer:
___________________________________________________
Date: _________________________
This promotion is available for the first 50 vehicles on a first-come-first-served basis. For general information about electric vehicles (EV)
and charging visit efficiencymaine.com/ev. For more information about this limited promotion for businesses, including rules about
eligibility and rebate limits, visit efficiencymaine.com/electric-vehicle-rebates/.
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Completed 23 July 2021

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