GA - 200 - Nissan USA

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 GEORGIA Electric Vehicle Supply Equipment Rebate ? Georgia Power

Short Description: Georgia Power offers a rebate to qualified residential customers and builders who

install Level 2 (209/240 volt) EVSE

Beneficiary: Georgia customers and builders who install Level 2 (209/240 volt) EVSE Type of Incentive: Cash Rebate Effective Dates: Current Benefit, effective through December 31, 2019 Value of Benefit: Up to $250 Full Description:

Georgia Power offers a rebate to qualified residential customers and builders who install Level 2 (209/240 volt) EVSE. Residential customers are eligible for a $250 rebate and new home construction builders are eligible for a $100 rebate for each dedicated circuit installed through December 31, 2019. Other conditions may apply. For more information, see the Georgia Power Electric Vehicles website. See rebate form below.

State Statutory References: N/A

Other Link(s):

AFDC Website: Georgia Power Website: Application Form:

Contact Information: N/A

RESIDENTIAL ELECTRIC VEHICLE CHARGER REBATE REQUEST FORM

RESIDENTIAL CUSTOMER - Level 2 (208/240V) Charger - $250 REBATE Please allow 4-6 weeks for processing

NOTE: Submit this form, along with a copy of paid installation and charger invoice(s), within 60 days after the electric vehicle (EV) charger has been installed.

Rebates will be paid to single family residential customers served by Georgia Power.

Rebates available for installations completed by December 31, 2018

INSTALLATION ADDRESS (Required)

CUSTOMER INFORMATION

OWNER INFORMATION

Owner Occupied

Rental

MAILING INFORMATION (If different from Installation Address)

Name: Address: City, Zip Phone Number: Georgia Power Account #:

Owner Information (if applicable) Name: Address: City, Zip: Phone Number:

Name: Address: City, Zip: Phone Number:

INSTALLATION AND EQUIPMENT INFORMATION

Installation and Charger Invoice(s) Must be Attached

INSTALLATION CONTRACTOR NAME:

Unit #

Installation Date

Charger Manufacturer

Charger Name / Model #

Charger Serial #

1 2 3

I certify the above information is true and correct and I agree to the Residential Electric Vehicle Charger Rebate Program Terms and Conditions summarized below and found in full at ev/. I certify that I am the property owner of, or that I received the property owner's permission to install the EV charger at the single family residence served by Georgia Power at the installation address provided above.

Customer Signature:

Date:

Print Name:

All electric vehicle chargers installed under this program are subject to visual verification by the Georgia Power Corporate Compliance Organization (GPCCO). If your EV charger installation is selected for a field audit, you will be contacted by a GPCCO representative to schedule an appointment. By signing and submitting this Rebate Request Form you agree to provide a GPCCO representative reasonable access to the installation site during normal business hours. If the field audit discovers that the EV charger has not been installed, the rebate will not be paid and you may be billed for repayment of the rebate to Georgia Power if the rebate has already been issued.

Terms and Conditions (Summary): Must be a Georgia Power customer. Program open to all single family residential customers regardless of electric service rate. Rebates available only for new, customerpurchased L2 (208/240V) chargers. By signing and submitting this Rebate Request Form, applicant affirms that all city, county, or state government, property owner, or homeowners association restrictions, rules, codes and regulations were complied with and all necessary permits were obtained prior to charger installation. Georgia Power reserves the right to cancel or modify this rebate program at any time in its sole discretion.

By signing and submitting this Rebate Request Form, applicant acknowledges and agrees that Georgia Power's liability and responsibility in connection with the Electric Vehicle Charger Rebate Program shall be strictly limited to the making of certain rebate payments for eligible equipment, and that Georgia Power is not making, will not be providing and specifically disclaims any representations, warranties, covenants or guaranties whatsoever, express or implied, in connection with the electric charger or the Program itself, including, without limitation, those regarding merchantability or fitness. Warranties with respect to the charger are strictly manufacturer's warranties, and applicant shall not make, nor have the right to make, any claims against Georgia Power relating to any such warranty. Georgia Power shall in no way be liable or responsible for any equipment installed by, or for any act or omission of, any other entity or individual, including, without limitation, equipment manufacturer, any electrician, technician, or other service provider.

Mail Form & Invoice to:

Georgia Power Electric Vehicle Charger Rebate 241 Ralph McGill Blvd. - BIN 10192 Atlanta, GA 30308

OR

Fax or Email Form & Invoice to:

Georgia Power Electric Vehicle Charger Rebate FAX # 1.800.539.3547 g2gpcsr@

For further information call your local Georgia Power Sales Representative or 1-800-524-2421 or ev ? 2017 Georgia Power Company. All rights reserved.

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