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45 <br />I <br />See back for details regarding specific rebate requirements. <br />When the time comes for you to make the switch to an electric vehicle, we want the process to be as convenient and easy as <br />possible. Receive up to a $700 rebate toward the purchase and installation of a hardwired (non -portable) 240-volt electric vehicle <br />(EV) charger for your home. Installation automatically qualifies for Electric Vehicle Charging Rates saving you even more money. <br />How to Receive a Rebate <br />(Valid forresidential customers of Elk River Municipal Utilities only Rebates come in the form ofa bill credit) 6 A <br />1 Complete the front and back of this rebate form. 4 Mail or bring to OR iEl <br />2 Include a copy of the original itemized sales receipt Elk River Municipal Utilities SCAN HERE <br />and/or invoice indicating the brand and model purchased. ATTN Rebate Program to submit' <br />MN 55330 Elk River, documents <br />3 Installation of 200-amp bypass meter socket and passed 13069 Orono Pkwy NW, � <br />inspection report from a state certified electrical inspector. OR Email customerservice@aermumn.com online. ❑� sue' <br />CUSTOMER INFORMATION (please complete all information below) <br />Name Phone County <br />Install Address City State Zip <br />Email Account # <br />RETAILER / CONTRACTOR / INSTALLER INFORMATION <br />Company Name <br />Mailing Address <br />CERTIFICATIONS AND SIGNATURE <br />Phone <br />City <br />State <br />Email -Address <br />Zip <br />I hereby certify that <br />• The information contained in this application is accurate and complete. <br />• All installation is complete, and the unit(s) is operational prior to submitting application. <br />• All rules of this rebate program have been followed. <br />I agree to verification of equipment installation which may include a site inspection by a program or utility representative. I understand that I <br />am not allowed to receive more than one rebate from this program on any piece of equipment. I agree to indemnify, defend, hold harmless <br />and release ERMU from any claims, damages, liabilities, costs and expenses (including reasonable attorney's fees) arising from or relating <br />to the removal, disposal, installation or operation of any equipment or related materials in connection with the programs described in this <br />application, including any incidental, special or consequential damages. <br />ERMU reserves the right to reject any rebate application submitted as a result of work performed by a contractor who has failed to adhere <br />to the terms and conditions established for the rebate program. <br />Homeowner Signature Print Name Date <br />