Ukiah Hardwired Level 2 EV Charger Rebate: Installation with Permit

How did you acquire the new hardwired Level 2 Charger?*

My contractor is supplying the device, included in the electrical job.

I purchased it separately.

What is the status of your project?*

Choose the option that fits best. Please contact us with any questions.

Work is scheduled or in progress. I have the Electrical Contractor's invoice.

Installation is finished. My Building Permit is not finalized yet.

Project is complete, and I have the finalized Building Permit.

Other

What is the status of your project?*

Choose the option that fits best. Please contact us with any questions.

I have my Charger invoice. The Electrician is not scheduled yet.

Work is scheduled or in progress. I have the Electrical Contractor's invoice.

Installation is finished. My Building Permit is not finalized yet.

Project is complete, and I have all my documentation including finalized Building Permit.

Other

Charger make / brand*

Charger model name / number*

Date of Charger purchase*

Upload Charger invoice/receipt*

Show customer information and address, charger make/brand and model, purchase date, and cost. Incomplete screen shots will not be accepted.

Drop files here or

Max. file size: 20 MB.

The Contractor's invoice needs to show:

Contractor name and license number
Customer name and installation address
Billing and/or shipping address, as applicable
Job description
Total cost
Date(s) of billing and/or service

If the contractor supplied the charger, the invoice needs to itemize it with make/model.

Upload Contractor invoice*

Incomplete screen shots will not be accepted.

Drop files here or

Max. file size: 20 MB.

Upload finalized Building Permit*

Drop files here or

Max. file size: 20 MB.

Applicant Name*

First Last

Are you the utility account holder at the service address?*

Yes

No

What is the account holder's name?

Utility account number

Service Address*

Street Address City State ZIP Code

Do you have a different mailing address?*

Yes

No

Mailing Address*

Street Address City State ZIP Code

Email*

Enter Email Confirm Email

Phone*

What is your Electric Vehicle type?*

All-Electric

Plug-In Hybrid EV

EV make & model*

EV year*

Notes

Include notes you would like on the application, or leave this box blank.

Applicant Release*

I have read and understand this application, including the Terms and Conditions linked at the end of this form.

I certify that the information I have provided in this application is true and correct.

Ukiah Hardwired Level 2 EV Charger Rebate: Installation with Permit

Before you begin

Requirements

Rebate: $500