EV Level 2 Smart Charger Rebate Application

Application Record Type ID

Member Information

Member Name

(as it appears on electric bill)

Electric Utility Account Number

(found on monthly bill)

Primary Phone

Enter your 10-digit phone number without the dashes.

Secondary Phone

Enter your 10-digit phone number without the dashes.

Service Address

(where equipment is installed)

City

State Abbreviation

Zip Code

Is your mailing address different than you service address?

YesNo

Mailing Address

City

State Abbreviation

Zip Code

Equipment Information

Provide information on the EV Level 2 smart charger purchased and installed:

Brand Name

Model #

Date Purchased

Date Installed

Cost of Charger

Upload a copy of the charger's sales receipt

Contractor Information

Company Name

Contractor Name

Street Address

City

State Abbreviation

Zip Code

Office Phone

Enter your 10-digit phone number without the dashes.

Cell Phone

Contractor Email

Contractor License Number

Contractor License Name

Cost of Installation

Upload Contractor Invoice

Rebate Payment Information

Total Rebate Requested

GLE members who purchase and permanently (hardwire) install a new Level 2 smart charger are eligible for up to a $800 rebate. Incentive amount cannot exceed the combined purchase and installation price.

Reminder: All rebates $100 or less will be credited to the account.

Who should the payment be made payable to?

MemberLandlord

How would you like to receive payment?

Mail check to service addressMail check to mailing addressCredit the electric account listed in the member information section

Landlord Name

Landlord Address

City

State Abbreviation

Zip

Terms and Conditions

I certify that this information is true and accurate. I understand that GLE reserves the right to inspect my EV charger installation at any time and may charge me the full amount of this rebate, plus interest should they find the information presented here to be false in any way.

Click here to read the Energy Wise Terms and Conditions

Type your name to electronically sign this application

Great Lakes Energy - Energy Wise