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Elk River Electric Vehicle Charger Installation <br /> Municipal Utilities 2017 Residential Rebate Application <br /> Customer Information <br /> Name Account# <br /> Address where EV charger is installed <br /> City State Zip <br /> Phone Email <br /> Electric Vehicle Charger Information <br /> Manufacturer Amps <br /> Charger Make/Model Electric Vehicle Make/Model <br /> Participate in time-of-use program n Yes 0 No <br /> I certify that my EV charger has been installed at the address listed above,and that this address represents a valid utility account. <br /> Signature Date <br /> Important: <br /> • Receive up to a$500 rebate towards the purchase and installation of a 240 volt EV charger for your home. <br /> •Applicant must have ERMU electric service to qualify for the rebate. <br /> • Contact our office at 763.441.2020 prior to purchasing charger to ensure rebate funds are still available. <br /> • EV charger must be installed in a residential home for on-road vehicles only. <br /> • Energy supplied to the EV service must be used for the sole purpose of electric vehicle charging. <br /> All other uses are prohibited. <br /> • Customer is responsible for the installation of a 200 amp bypass meter socket,and inspection by a State <br /> Certified Electrical Inspector.Upon completion of inspection,ERMU meter technicians will install the meter. <br /> •To apply for rebate,complete the EV Charger Program Rebate Application.Submit rebate application <br /> and a copy of the sales receipt by December 31,2017 to: <br /> Elk River Municipal Utilities, 13069 Orono Parkway,PO Box 430,Elk River,MN 55330 <br />