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2. NOTE: Submitting this document electronically will require you to upload documentation such as sales receipt, etc.  Please do not send sensitive information.

4. 
6. Rebate Policy
   Program Specific Rules and Application Process

   Check out the Rules & Requirements section to make sure you qualify for this rebate before filling out the form.

8. Check this box to acknowledge that you have read and agree to our rebate policy Rules & Requirements.*

   1. Yes

10. Submitting this document electronically will require you to upload documentation such as sales receipt, etc.  Please do not send sensitive information.

12. Select Qualifying Purchase Date:*

    1. Receipt dated within last 12 months.
    2. Receipt older than 12 months from current date. (Sorry does not qualify)

    Customers must apply for rebates within twelve (12) months of the purchase date shown on the sales receipt.

14. Is installation complete?*

    1. Yes
    2. No. Sorry, not yet eligible for rebate.

    Equipment must be installed and project complete before applying for rebates.

18. Anoka Municipal Utility (AMU) Customer Information

    You must have an address that is serviced by Anoka Municipal Utility (AMU). 

20. Anoka Municipal Utility (AMU) is my electric service provider.*

    1. Yes
    2. No, sorry this rebate is for AMU customers only.
22. Customer Name*
23. Customer Last Name*
25. Service Address*

    Rebate amount will be credited to your AMU billing account. No need for a mailing address. This must be the location of installation for the rebate.

27. City*
28. State
29. Zip*
31. Phone Number*
32. Email Address
36. Electric Vehicle (EV) Information

    For proof of Full Battery (BEV) or Plug-in Hybrid (PHEV).

38. I certify that I own the following type of Electric Vehicle (EV).*

    1. Fully Batter Electric Vehicle (BEV)
    2. Plug-in Hybrid Electric Vehicle (PHEV)
    3. Hybrid Electric Vehicle (HEV). Sorry, does not qualify for rebate.

    
    

    NOTE:  AMU reserves the right to conduct random inspections at anytime to verify vehicle at the address indicated on this form. Inspections may be performed after the rebate payment at AMU’s discretion. If AMU inspects the vehicle and finds it to be any other than stated in this application, rebate amount may be charged back via utility billing.

40. Is the applicant the owner of the Electric Vehicle (EV)?*

    1. Yes
    2. No
42. Owner First Name*

    Owner must live at AMU applicant's residence.

43. Owner Last Name*

    Owner must live at AMU applicant's residence.

45. Vehicle Year*
46. Vehicle Make*
47. Vehicle Model*
51. EV Charger 2 Information
53. Retailer Name/Store:*
55. Location/City*
56. State
58. Receipt Date*
    Receipt Date
61. Receipt Dated within the last 12 months*

    1. Yes
    2. No
63. Upload Your Receipt for EV Charger 2*

    Receipt(s) submitted must include Retailer Information and Purchase date along with EV Charger 2 information for proof of purchase.

    Take a picture from your phone, a screen shot, or scanned copy of original receipt. 

65. Upload Second Page of Receipt (if applicable)
69. Equipment Information
71. EV Charger Level*

    1. Level 1, sorry does not qualify for rebate.
    2. Level 2
    3. Level 3, sorry does not qualify for rebate.

    Must be a Level 2 charger to qualify for rebate at this time.

73. EV Charger Type*

    1. Full Battery EV
    2. Plug-In Hybrid
75. EV Charger Installation Date*
    EV Charger Installation Date
77. EV Time-Of-Use (TOU) Meter Installed?*

    1. Yes
    2. No, Sorry does not qualify for rebate.
79. EV Time-Of-Use (TOU) Meter Installation Date*
    EV Time-Of-Use (TOU) Meter Installation Date
81. EV Time-Of-Use (TOU) Program Active?*

    1. Yes (Required)
    2. No (Sorry, does not qualify for rebate)
85. Disclaimer & Signature
87. Check this box to agree to the following:*

    1. I certify that all the information provided is accurate including claims of efficiency, size and customer information. I agree that AMU may verify all the information I have provided.
89. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
91. Electronic Customer Signature*

    *Must have an AMU account holder name here.  Any other name not listed on the utility bill will result in rejection of this rebate application.

Leave This Blank:


92. 1. Receive an email copy of this form.
93. Email address

    This field is not part of the form submission.

94. Submit Submit and Print

* indicates a required field