VI Energy Office Equitable E-Mobility Rebate Program

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)?*

Business or Entity Name

District*

Select or enter value

Email*

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*

Select

Zip*

Purchase Date*

Vehicle Information

Vehicle Type

Electric Car/Truck/Van

E-Bike

Make/Brand*

Select or enter value

Model/Model Number*

Year*

Color

Select or enter value

VIN/Serial Number*

Mileage*

Mileage at time of sale.

VI Registration Date

Purchase Price*

Invoice price of vehicle or Receipt price of E-Bike

(number only)

Questionnaire

What will you do with your old vehicle?

Select or enter value

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

Select or enter value

What was your average gas expenditure monthly?

Solar installed at your primary charging location?

Select or enter value

What is your monthly mileage driven?

Required Attachments

File Upload

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

Drag and drop files here or

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.

W9*

Drivers License*

Vehicle purchase agreement or Ebike Receipt*

Signed Equitable E-Mobility Terms and Conditions

Tax Exemption Certification

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.

I intend to retain this e-bike for at least one (1) year 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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