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EV Smart Charging Form_

    How did you hear about the program?
    Farmer's MarketWMGLD WebsiteNewspaperOther

    Installation Address (please do not list P.O. Box #)

    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.