Electric Commuter Bicycle Rebate Form

SMPA Member Information

First Name

(Name on Bill)

Last Name

(Name on Bill)

Enter your Account #

Best contact if any issues with processing

Phone

Best contact if any issues with processing

New Construction?

YesNo

Is the Mailing Address the same as the Equipment Location Address?

YesNo

Mailing Address

Street

City

State

(Please use Postal Format. (example: "CO"))

Zip Code

Rebate To Be Paid To Contractor?

YesNo

Contractor Name

Contractor Street

Contractor City

Contractor State

(Please use Postal Format. (example: "CO"))

Contractor Zip Code

Application ID

Billing Account Lookup

Salesforce Account

Salesforce Contact

Record Type ID

Program

Equipment Location Data

First Name	Last Name
Street	City
State (Please use Postal Format. (example: "CO"))	Zip Code

Information About Electric Bicycle

E-Bike Brand

Model

Model Number

Intended Use

CommuteWorkOther

Please describe use if you selected "other" intended use.

Upload Attachments Here

Upload Itemized Receipts Here

Applications submitted without a receipt will be considered incomplete and will not be processed

Please upload a spec sheet or supporting documentation

Only current San Miguel Power Association members qualify for rebates. Please allow 90 days for complete rebate processing. An application submission does not guarantee a rebate. San Miguel

Power Association reserve the right to inspect and verify appliance installation to process any rebates.

Application must be complete and an itemized receipt verifying purchase must be included. All applications must be submitted by December 15 to be eligible for posted incentive amount. Incomplete applications may be denied.

If you have any issues with your application or with uploading documents, please email rebates@smpa.com or call us at 970-626-5549.