LIPA Plug In Electric Vehicle Rebate

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1 This does not constitute tax advice. All persons considering use of available incentives should consult with their own tax professional to determine eligibility, specific amount of benefit available, if any, and further details. STATE OF NEW YORK LIPA Plug In Electric Vehicle Rebate Short Description: Long Island Power Authority (LIPA) will provide a $500 rebate to residential customers who purchase a qualifying plug in hybrid electric or all electric vehicle. Beneficiary: LIPA customers who purchase a plug in vehicle. Type of Incentive: Cash rebates of up to $500. Effective Dates: Effective from December 20, 2010 thru December 31, Value of Benefit: Rebate of up to $500 Full Description: Long Island Power Authority (LIPA) offers mail in rebates of up to $500 to residential customers who purchase allelectric or plug in hybrid electric vehicles. The vehicles must be purchased, registered, and owned by the LIPA customer during the period beginning December 20, 2010, and ending December 31, To obtain the rebate, qualified customers must complete the rebate application form (reproduced below and found on the LIPA website linked below) and send it in with the appropriate documentation. State Statutory references: Not applicable Other Link(s): (AFDC website) Contact Info: LIPA: or

2 LIPA Plug-In Hybrid Electric and Plug-In Electric Vehicle Rebate Program Customer Application Form IMPORTANT: PLEASE READ THE FRONT AND BACK OF THIS FORM THOROUGHLY BEFORE COMPLETING AND KEEP A COPY FOR YOUR RECORDS. Customers are asked to please submit only one application. Customer is responsible for informing LIPA of any updates to this application. LIPA Electric Account Number at Customer Address: Customer Name: Mailing Address (if different): Daytime Telephone: ( ) Cell Phone: address: Vehicle Purchase Date: / / Vehicle Purchase Location: For a limited time only, LIPA is offering a one-time only $500 mail-in rebate to LIPA residential customers that are located in the LIPA Service Territory who purchase and register a new, qualified Plug-In Hybrid Electric Vehicle ( PHEV ) or Plug-In Electric Vehicle ( PEV ). This rebate is valid for passenger vehicles only and does not apply to leased, commercial, or restricted use vehicles. Qualified PHEVs or PEVs are defined as follows: Plug-In Hybrid Electric Vehicle (PHEV), also known as a plug-in hybrid, is a hybrid vehicle with rechargeable batteries that can be restored to full charge by connecting a plug to an external electric power source. A PHEV shares the characteristics of both a conventional hybrid electric vehicle, having an electric motor and an internal combustion engine, and of an all electric vehicle, also having a plug to connect to the electrical grid. Plug-In Electric Vehicle (PEV) is powered by an all electric motor rather than a gasoline engine and can be connected by a plug to the electrical grid. A PEV is also combined with rechargeable batteries that can be restored to full charge by connecting a plug to an external electric power source. This rebate is good for purchases made December 20, 2010 through December 31, The LIPA residential customer s rebate form and all documentation must be sent to LIPA and postmarked no later than January 31, LIPA will issue the rebate to the LIPA residential customer having a LIPA residential customer account in either the form of a check mailed to the customer or in the event there is an account arrears, LIPA will credit the rebate to such amount and then issue the balance of the rebate amount to the customer via check. After completion of all the steps listed on Page 4 of the Rebate application, please allow up to 60 days for the delivery of the rebate check or a credit to the LIPA residential customer s account. Successful purchase of the PHEV or PEV and submission of all documentation is required before the rebate check or credit will be issued. To receive your rebate, please fill out this form completely and mail it to the address listed on Page 4. 1

3 Eligible Vehicle Information Vehicle Manufacturer: Vehicle Model: Vehicle Model Year: Vehicle Identification Number (VIN): Vehicle Category (Check one) : PHEV: PEV: To process the PHEV/PEV Rebate, LIPA will require a completed Plug-In Hybrid Electric and Plug-In Electric Vehicle Rebate Customer Application Form, a copy of a valid Bill of Sale, and a copy of the New York State vehicle registration for the qualifying purchase of a PHEV or PEV that was purchased between December 20, 2010 through December 31, The LIPA residential customer s rebate form and all required documentation must be sent to LIPA and postmarked and received by LIPA by 5pm on January 31, I understand this rebate is for one per Eligible LIPA Customer and is a one-time only rebate. I certify that I am an Eligible LIPA Customer and I have purchased a PHEV or PEV as defined in the eligible vehicle description above and have provided all the necessary documentation and proof of vehicle purchase to meet eligibility requirements for this LIPA rebate. I have reviewed and agree to the terms and conditions stated on both sides of this application. I understand that any attempt to misrepresent information in this application will disqualify me from all claims to this rebate through LIPA s Plug-In Electric Hybrid and Plug-In Electric Vehicle Rebate Program. Customer s Signature: Date: / / 2

4 LIPA Plug-In Hybrid Electric and Plug-In Electric Vehicle Rebate Program Customer Application Form Eligibility Requirements 1. To qualify for this rebate, you must be a LIPA residential customer that has an account that (i) has no past due balance as of the date of this application, or (ii) agrees that LIPA will credit the $500 rebate amount to any past due/arrears amounts ( Eligible Customer ). LIPA will credit the rebate to such amounts and then issue the balance of the rebate amount to the customer via check. 2. This rebate is for one per Eligible LIPA Customer and will be a one-time only $500 mail-in rebate for qualifying PHEVs or PEVs as defined on page 1 of this application. 3. Qualifying PHEVs or PEVs must be purchased and registered by the Eligible LIPA Customer beginning December 20, 2010 and no later than December 31, The rebate applies to passenger vehicles only, and does not apply to leased, commercial or restricted use vehicles /2011 qualifying PHEVs and PEVs are currently limited to the Chevrolet Volt (PHEV) and the Nissan Leaf (PEV). 5. Eligible LIPA Customers who have purchased a PHEV or PEV must submit to LIPA (i) a signed and completed Plug-In Hybrid Electric and Plug-in Electric Vehicle Rebate Program Customer Application Form, (ii), a copy of a valid Bill of Sale, and (iii) a copy of a valid New York State vehicle registration which indicates customer name and address to be the same as indicated on this form. All documents must be received by LIPA and Postmarked no later than January 31, LIPA reserves the right to inspect the Bill of Sale in order to ensure compliance with program requirements. 7. LIPA will not be responsible for any costs, liabilities or expenses associated with the PHEV or PEV purchases, including, but not limited to sales tax, inspection, registration or tax liability. 8. LIPA reserves the right to modify the terms and condition of this rebate and/or withdraw this rebate program at any time. After completion of all the steps listed on Page 4 of the Rebate application please allow up to 60 days for the delivery of the rebate check or a credit to the LIPA residential customer s account. Successful purchase of the PHEV or PEV and submission of all documentation is required before the rebate check or credit will be issued. 3

5 Instructions to Process the PHEV / PEV Rebate: STEP 1. STEP 2. STEP 3. PHEV /PEV documents can be downloaded from LIPA s web site at Incomplete applications and missing documentation will delay or prevent the processing of an application. Eligible LIPA Customers must use a copy of this form to submit any changes or updates to the information originally provided with their original application and send these updates to or mail to the address listed below. Complete and sign this rebate application. A fully completed application and all the appropriate information are necessary for application processing. Submit to LIPA the completed original PHEV/PEV rebate application, copies of valid Bill of Sale from a qualified vehicle purchase and NYS vehicle registration, and send them to: LIPA Plug-in Hybrid Electric Vehicle/Plug-In Electric Vehicle Program Rebate Processing 25 Hub Drive Melville, NY STEP 4. When the LIPA PHEV/PEV Rebate application is approved, Customers will then receive an approval letter for the rebate payment, which will be processed for payment within approximately 60 days of receipt. Include your LIPA account number on all correspondence. For more information, visit or call

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