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How did you hear about the program? Farmer's MarketWMGLD WebsiteNewspaperOther
Your Name (required)
WMGLD Customer Number
Installation Address (please do not list P.O. Box #)
Street Address
Home Phone
Cell Phone
Your Email (required)
Please attach requested documents below (PDF or JPG accepted) Receipt for Chargepoint Home Flex Charger (6MB max.): Proof of EV Ownership (6MB max.): Copy of signed On-peak Charging Agreement (6MB max.):
By submitting this form, I certify that I have purchased an electric vehicle and I am an electric customer of WMGLD. I am providing the requested information solely to be eligible to receive a rebate through this program and request that the personal information supplied by me be treated as confidential.
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