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2. 
3. Electric Vehicle Charging Station Incentive

   Applicants must have completed installation by a licensed electrician. Customers must be in good standing. Charging station must be enrolled in our Connected Homes Program to receive rebate. Submissions valid from 1/1/22-12/31/22. IELD reserves the right to end these rebates at any time.

7. Account Holder Information
9. Electric Account #*
10. First Name
11. Last Name*
13. Phone Number*
14. Email Address*
15. Service Address*
17. Mailing Address
    (if different from service address)
18. City
19. State
21. Zip
22. Receipt/Work Order*
    *Please upload all dated invoices/work orders that document the installation. Invoices and/or work orders should include the name, license number, address and phone number of the electrician that completed the installation.
23. Installed Station Photo*
    *Please upload a photo of your newly installed EV charger.
25. Total Rebate Amount Requested*
26. Device is enrolled In Connected Homes Program?
    -- Select One --YesNo
32. Electrician Information
34. Electrician Name*
35. License Number *
37. Phone Number
39. Mailing Address
41. City
42. State
43. Zip
45. Customer Acknowledgement
    By submitting this form, I hereby request a rebate for the listed work. I certify that a licensed contractor has installed the measures listed in accordance with state and local codes.
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47. 1. Receive an email copy of this form.
48. Email address

    This field is not part of the form submission.

49. Submit

* indicates a required field