Applicant Information

Please note this is a preliminary application and that submission of this form does not guarantee grant funding will be awarded. After submitting your application, you will receive a confirmation email from AOT.climate@vermont.gov with next steps.

You must wait until your application is fully approved before you may purchase your electric fleet vehicle to be eligible for an Electrify Your Fleet incentive reimbursement payment.

If your application is approved, this information will be used to draft the grant agreement. Please ensure the information in all fields is accurate and error-free.

You may preview the entire application in this read-only PDF: ElectrifyYourFleetApplicationPreviewPDF.pdf (vermont.gov)

You must complete this online application to be considered for funding.

For more information, Electrify Your Fleet Program Guidelines can be found on the Agency of Transportation website.

Questions with an asterisk (*) are required and must be answered to complete the application.

If you are a non-English speaker and need translation assistance, please email AOT.climate@vermont.gov to be connected with State-contracted translation and interpretation services. Share your name, phone number, and email address so we can contact you with a translator on the line.

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* 1. Select your fleet category:

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* 2. Please select the descriptors that apply to your organization.

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* 3. Is this your first application to the Electrify Your Fleet Program?

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* 4. Organization Name

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* 5. Organization Address

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* 6. Contact Name

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* 7. Contact Title

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* 8. Contact Information

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* 9. Fiscal Year End Month

Select the last month of your organization's fiscal year. For example, the State of Vermont fiscal year ends in June.

A State Vendor Number is required to enter into a Grant Agreement with the State of Vermont. Completion of this pre-approval form does not guarantee a grant award will be issued.

If you have a State Vendor Number, please enter it below.

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* 10. State of Vermont Vendor Number

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* 11. If you do not have a State of Vermont Vendor Number, you will need to submit a hand-signed W-9 dated within the last 6 months.
Download the W-9 form here: Form W-9 (irs.gov)
Fill, print, and sign the completed form in ink. Then scan the form or take a high quality picture and upload the digital copy here.
Electronic signatures will not be accepted.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
If you have a Unique Entity Identifier (UEI) number, please enter it below.

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* 12. Unique Entity Identifier (UEI)

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