Chargewise Enrollment Form

Phone

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Member Information

To receive a Chargewise rebate your EVSE must be enrolled in a load management program. Please contact your cooperative at (218) 429-0432 to get started.

Name(Required)

First Last

Account Number(Required)

Address where EV charger is installed(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

EV Make/Model(Required)

Maximum electric range (miles per charge):(Required)

Electric Vehicle Information

Make(Required)

Model(Required)

Year(Required)

VIN Number(Required)

License plate number(Required)

Purchase Date (mm/dd/yyyy)(Required)

Contractor Information

Name(Required)

City(Required)

State(Required)

Rebate is available for the installation of a Level 2 EV charger installed on or after January 1, 2021. The charger must be installed where electricity is supplied by your electric cooperative and controlled on an off-peak rate. Rebate submittal must follow the guidelines as outlined by the cooperative. Your electric cooperative is not responsible for inaccurate information supplied by vendors.

Rebate amount is up to $500 to offset the cost to install an EV charger controlled on an off-peak rate.
EV charger must be installed within cooperative’s service territory.
Additional outlets for your EV that are not off-peak outlets are prohibited when participating in the storage program.
Fill out this form completely. Incomplete forms will not be processed.
Include your account number and sign the form.
Submit completed rebate form and a copy of the electrician’s bill for wiring the charger or outlet within one year of purchase
Rebate program is subject to change or cancellation without notice.

Member Consent(Required)

I hereby verify the information to be true and complete and agree to the terms and conditions. I understand that by typing my full name and pressing the Submit button, this form submission will be stamped with today’s date and authorized by me as if I had signed my signature.

Member Electronic Signature (Full Name)(Required)