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ELECTRIC VEHICLE CHARGER INSTALLATION <br />REBATE APPLICATION <br />ERMUMN.COM | 763.441.2020 | 13069 ORONO PARKWAY | PO BOX 430 | ELK RIVER, MN 55330-0430 <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 />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 />• Receive up to a $500 rebate towards the purchase and installation of a 240-volt EV charger for <br />your home. <br />• Applicant must have ERMU electric service to qualify for the rebate. All rebates will be given in <br />the form of a credit on your electric utility bill. <br />• Contact our office at 763.441.2020 before purchasing a charger to ensure that funds are still <br />available. <br />• EV charger must be for on-road vehicles. <br />• Energy supplied to the EV service must be used for the sole purpose of electric vehicle <br />charging. All other uses are prohibited. <br />• Customer is responsible for the installation of a 200-amp bypass meter socket and inspection <br />performed by a state certified electrical inspector. Upon completion of inspection, ERMU meter <br />technicians will install the meter. <br />• Submit the completed rebate application and a copy of the invoice or itemized receipt, <br />indicating the brand and model purchased, to ERMU by mail or electronically on our website at <br />www.ERMUMN.com. <br /> IMPORTANT: <br />127