VI Energy Office
Equitable E-Mobility Rebate Program

***Before Completing this application please be sure to have all required documents available to upload directly to the application***

Applicant Information

First Name

Last Name

Last 4 Digits of SSN or EIN

Is this item for a business or 501(c)(3)?

District

Physical Address

City/Island

State

Zip Code

Mailing Address

City/Island

State/Territory

Zip Code

Telephone 1

Phone

Telephone 2

Phone

Vendor Information

Dealership Name

Dealer Address

City

State

Zip

Purchase Date

mm/dd/yyyy

Vehicle Information

New or Used

Make/Brand

Model/Model Number

Year

Color

VIN/Serial Number

Mileage

Mileage at time of sale.

VI Registration Date

mm/dd/yyyy

Purchase Price

Invoice price of vehicle or Receipt price of E-Bike

(number only)

Questionnaire

What will you do with your old vehicle?

Would you have purchased an electric vehicle if a rebate was not offered?

What was your average gas expenditure monthly?

Solar installed at your primary charging location?

What is your monthly mileage driven?

Required Attachments

File Upload

Upload IRS W-9 Form, Applicant ID, Bill of Sale, and Registration

Drop your files here

Check off attached files below to confirm Upload

Be sure the address listed on the W9 form is where you want your rebate check mailed.

Drivers License

Vehicle purchase agreement or Ebike Receipt

Signed Equitable E-Mobility Terms and Conditions

Vehicle Title OR Vehicle Loan Lien Letter

USVI Registration

Signature

I intend to retain this vehicle for at least three (3) years from the purchase date.

Declaration

By typing your name below you hereby declare that the information given above and in the enclosed documents is true to the best of your knowledge and belief and nothing has been concealed therein.

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