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ELECTRIC VEHICLE CHARGER INSTALLATION <br />REBATE APPLICATION <br /> CUSTOMER INFORMATION <br />Name Account # <br />Address where EV charger is installed <br />City State Zip <br />Phone Email <br /> <br /> ELECTRIC VEHICLE CHARGER INFORMATION <br />Manufacturer Amps <br />Charger Make/Model Electric Vehicle Make/Model <br />Participate in time-of-use program Yes No <br />Signature Date <br /> IMPORTANT: <br />500 rebate towards the purchase and installation of a 240 volt EV charger for <br />your home. <br /> ce at 763.441.2020 prior to purchasing charger to ensure rebate funds are still <br />available. <br />charging. All other uses are prohibited. <br />200 amp bypass meter socket, and inspection <br />by a State Certi ed Electrical Inspector. Upon completion of inspection, ERMU meter <br />technicians will install the meter. <br />indicating the brand and model purchased. Application and receipts can be submitted via mail, <br />fax, or electronically on our website at www.ERMUMN.com. <br />ERMUMN.COM | 763.441.2020 | 13069 ORONO PARKWAY | PO BOX 430 | ELK RIVER, MN 55330-0430 <br />208 <br />