Electric Vehicle Pre-Sales Form

2018 Electric Vehicle Pre-Vehicle Purchase Form

Section A: MEMBER INFORMATION
Member Name (as it appears on NHEC bill)*
NHEC Account Number*
Mailing Address*
Street Address Address Line 2 City State ZIP Code
Physical Address*
Street Address Address Line 2 City State ZIP Code
Daytime Phone #*
Email*
How did you hear about this rebate?
Section B: Electric Vehicle Information
My Electric Vehicle will be
Electric Vehicle Classification
Vehicle Make
Vehicle Model
Vehicle Year
VIN # (used model only):
Section C: Signatures
I have read and understood all materials, including the Terms and Conditions*
- Yes
Read the terms and conditions by clicking here.
Member Signature*
Date*
MM slash DD slash YYYY

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Section A: MEMBER INFORMATION