Charge NY Drive Clean Rebate

Company Information(Step 1 of 6)

Please do not copy or share the URL shown in your browser for this page. It is unique to you. If you would like to share the sign-up link, copy and share this link: https://nyserda.ny.gov/EV-Dealer-Sign-Up

To complete your dealership contractor application, please do the following:

Download and review the Charge NY Drive Clean Rebate Program Dealer Agreement (PDF).
Download and review the Program Implementation Manual (PDF), which is included by reference in the agreement.

Please provide your company information as detailed below. This is in place of a W-9 form - you may skip questions that may not be relevant to you.

The Legal Business Name must match the name associated with your Employer Identification Number (EIN). If it does not, your application will be rejected. If you use a DBA, please enter it in the Business Name / Disregarded Entity Name field.

Legal Business Name

Business Name / Disregarded Entity Name

Business Website

Street Address 1

Street Address 2

City

State/Province

Zip/Postal Code

What kind of business do you have? (select all that apply)

Please Select if Applicable (check all that apply)

New York State registered or New York City certified Minority Owned Business Enterprise (MBE)

New York State registered or New York City certified Women Owned Business Enterprise (WBE)

New York State Service-Disabled Veteran-Owned Business Enterprise (SDVOBE)

NYS M/WBE or SDVOBE Certification number(s)

Exempt Payee Code

Tax identification type:

Employer Identification Number (EIN)

Social Security Number (SSN)

Employer Identification Number (EIN)

Your Employer Identification Number (EIN) is not your Social Security Number.
See the IRS Form W-9 instructions for more information. IRS Form W-9 Instructions

Do not submit a Social Security Number to NYSERDA on this form.
If, in accordance with the rules on IRS Form-W9, your taxpayer identification number is a Social Security Number, complete all other information on this form and leave Employer Identification Number blank. In addition, mail a printed and signed copy of IRS Form W-9 to NYSERDA, attention to NYSERDA Finance, 17 Columbia Circle, Albany, NY 12203. Include your auto-generated Application Number on this and any forms submitted by mail to NYSERDA. You will receive your Application Number upon submission of your application.
Click to view or print the IRS Form W-9