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Dealership Information

In which state are you a licensed auto dealership?*

CA
IL
MO
NJ

What region do you serve?*

Los Angeles
San Diego
Sacramento

Name of Dealership or Retail Point in Los Angeles*

If you operate more than one store, please select just one option from the dropdown list. You can indicate additional makes sold at this location in the form below. A separate application will be required for any additional stores operating at a different physical location.

Name of Dealership or Retail Point in San Diego*

If you operate more than one store, please select just one option from the dropdown list. You can indicate additional makes sold at this location in the form below. A separate application will be required for any additional stores operating at a different physical location.

Name of Dealership or Retail Point in Sacramento*

If you operate more than one store, please select just one option from the dropdown list. You can indicate additional makes sold at this location in the form below. A separate application will be required for any additional stores operating at a different physical location.

Name of Dealership or Retail Point in New Jersey*

If you operate more than one store, please select just one option from the dropdown list. You can indicate additional makes sold at this location in the form below. A separate application will be required for any additional stores operating at a different physical location.

Name of Dealership or Retail Point in Massachusetts*

If you operate more than one store, please select just one option from the dropdown list. You can indicate additional makes sold at this location in the form below. A separate application will be required for any additional stores operating at a different physical location.

Dealership Name

If you operate more than one store, please select just one option from the dropdown list. You can indicate additional makes sold at this location in the form below. A separate application will be required for any additional stores operating at a different physical location.

Name of Dealership or Retail Point*

Vehicle Makes

What makes do you sell at your store?

Please list ALL makes sold, even if they are part of the dealership's name.

What makes do you sell at your store?*

Please list ALL makes sold, even if they are part of the dealership's name.

Dealership Address

Street Address Address Line 2 City State ZIP

Name of the Approving Authority*

Must be an individual with signing authority on behalf of the dealership.

First Last

Title of the person named above

Dealership Phone (Main)

Contact person's name*

First Last

Contact person's title or role

Contact Phone (Cell)

Contact Email*

Applicant Questionnaire

1) How many total new vehicles has your dealership sold over the last 12 months?*

Please enter a number less than or equal to 9999.

2) How many total new EVs has your dealership sold over the last 12 months?*

Electric vehicles (EVs) are any vehicles that can be plugged in.

Please enter a number less than or equal to 9999.

3) What is the total # of sales staff at your dealership?*

Please enter a number less than or equal to 9999.

4) How many of these sales staff sell plug-in vehicles?*

Please enter a number less than or equal to 9999.

5) Are all of the sales staff who sell plug-in vehicles at your dealership trained to sell electric vehicles?*

Yes
No

How would you rate support for plug-in cars from top management at your dealership?

6) What percentage growth in EV sales would you like to see at your dealership over the next 12 months?

Please enter a number less than or equal to 9999.

7) Please share any additional goals or other information related to plug-in vehicles.

Please use the space below to state them.

Program Terms and Conditions

By checking this box I signify that we are a manufacturer-certified EV dealer.*

You must be an OEM-certified EV dealer in California, Illinois, Missouri, or New Jersey to participate in this program.

Yes

Dealers acknowledge the following program requirements:*

-Assign at least two experienced sales staff as EV specialists
-EV specialists must complete PlugStar Certification training and maintain their standing with periodic refresher training
-All other sales staff may complete basic in-dealer PlugStar training (typically an hour or less in duration)
-Support local EV events with vehicles and staff as best able
-Share EV inventory and pricing information with Plug In America in a timely manner and on at least a monthly basis until automated
-Ensure a hassle-free buying process for EV shoppers and resolve customer issues in a timely manner

Continuation in the program, including eligibility for utility-funded dealer incentives (if available), is contingent upon compliance with the terms above. By checking this box, the applicant agrees to these terms.

Yes

Acceptance by Plug In America grants participating dealers a limited license to use its training material and resources for the purpose of the program only. By checking the box below you acknowledge the terms herein and agree to comply with the requirements set forth for the duration of the program or until December 31, 2020, whichever comes first*

Utility-funded dealer incentives for EV sales (where available) are disbursed as funds are made available to Plug In America. In the event of a funding shortfall and where replenishment of funds is anticipated, Plug In America reserves the right to maintain a wait-list with the goal of disbursing funds in the order of the date of sale.

Yes

For San Diego based dealerships, sales incentive eligibility is contingent upon active NCDA of San Diego membership in good standing and sale of an EV to SDG&E customers that choose an eligible EV rate. By checking the box below you acknowledge and accept these terms.*

Yes

Signature*

To re-enter your signature, click the refresh button on the bottom right of the signature block outline above.

New Jersey Program Payment

There is a fee of $2896 to enroll in the New Jersey PlugStar program. Please select your payment method.*

First 5 dealers in PSE&G's service territory and first 5 dealers in Atlantic City Electric's service territory receive $1,000 off. This discount will be reflected on your invoice. We will contact you regarding payment.

Check
ACH
Credit Card (you will be contacted for payment)

Plug In America - Check Payment

You will be invoiced by Plug In America's Finance Department for the final amount owed within 2-3 business days. Once you have received the invoice, you are required to make the full payment within 7 days of the invoice date.

Mail check to:
Plug In America
Attn: Finance Department
6380 Wilshire Blvd Suite 1000
Los Angeles, CA 90048

Confirmation*

I have reviewed the information stated above

Credit Card Payment

After your application has been reviewed, a program representative will contact you for credit card payment.

Confirmation*

I have reviewed the information stated above

Plug In America Electronic Funds Transfer (EFT/ACH)

Payor Direct Deposit Authorization Form

Authorization:
Plug In America authorizes the Payor mentioned below to initiate deposit electronic transactions and credit entries by ACH or EFT to deposit any owed amount invoiced by Plug In America directly into the bank account indicated below. Plug In America authorizes its Financial Institution to post these transactions to its bank account. This authorization is specific only to deposit type transactions and not any other type of transactions. Plug In America does not authorize any fees to be deducted to process these ACH/EFT transactions. This authorization is to remain in force and effect until Plug In America sends written notification to Payor to cancel or change this authorization. Each time a payment is made, please send notification to the email address listed below.

Plug In America Contact Information:
Plug In America
Attn: Finance Department
Address: 6380 Wilshire Blvd Suite 1000, Los Angeles, CA 90048
Tel: (323) 372-1236 ext 020
Email: aabou-ismail@pluginamerica.org

Financial Institution:
Bank: Wells Fargo Bank
Bank Address: 6301 Wilshire Blvd. Los Angeles, CA 90048
Bank Telephone Number: (800) 225-5935

Plug In America Bank Account Information:
Account Name: Plug In America
Account Number: 8759509006
Routing Number: 125008547
Account Type: Checking

Payor Company Name*

Payor Contact Person*

First Last

Payor Contact Person's Telephone Number*

Payor Contact Person's Email Address*

Payor Billing Address*

Street Address Address Line 2 City State ZIP Code

Authorized Signature*

To re-enter your signature, click the refresh button on the bottom right of the signature block outline above.

Signee Full Name*

First Last

Signee Title*

Date*

Apply

Dealership Information

Vehicle Makes

Applicant Questionnaire

Program Terms and Conditions

New Jersey Program Payment

Plug In America - Check Payment

Credit Card Payment

Plug In America Electronic Funds Transfer (EFT/ACH)

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