Rebate

REBATE APPLICATION

1 Step 1: Review Guidelines
2 Step 2: Complete Application
3 Step 3: Upload Documents

Before starting the online application process, please have all of the following required documents ready to be uploaded with your application:

Purchase or lease agreement
Temporary or permanent registration
Proof of current insurance
Proof of residency within the San Joaquin Valley

Your online application will not be accepted or saved unless these documents are attached.

Application Information

First Name

Last Name

Mailing Address

City

State

Zip Code

Physical Address

City

State

Zip Code

Primary Phone

Alternate Phone (optional)

E-mail Address

County of Residence

Have you ever applied for other Valley Air District grant programs?

Yes

New Vehicle Information

Estimated Annual Mileage

Estimated Use in San Joaquin Valley (%)

Estimated Use in California (%)

Purchase/Lease Date

Year

Make

Model

Vehicle Identification Number (VIN)

Amount Paid

CERTIFICATIONS

Certify

As a rebate recipient of the District’s Drive Clean in the San Joaquin Program, applicant commits to the following by signing this Certifications form:

Applicant shall retain ownership and maintain insurance (as required by CA state law) of the new vehicle for a minimum of 30 consecutive months immediately after the vehicle purchase or lease date. Applicant must immediately notify the District in writing if the following occurs within this 30-month period:
- Applicant intends to re-sale or return the vehicle to a dealer. Re-sale of the vehicle or returning it to a dealer within this 30-month period is allowed if necessitated by unforeseen or unavoidable circumstances AND only if applicant has been provided approval by the District. However, resale of the program-funded vehicle for financial gain within 30 months of purchasing or leasing the vehicle is not allowed. Applicant shall notify the District prior to re-selling or returning the vehicle.
- Vehicle is deemed a total loss due to an accident or vandalism.
- Applicant intends to relocate residency and current registration of the new vehicle outside District boundries.
In each of these instances, the District reserves the right to recoup all or a pro-rated amount of the original rebate amount from the applicant and/or pursue any other legal actions deemed appropriate.
Applicant authorizes the District to periodically confirm the new vehicle’s DMV registration and other pertinent information utilizing the District’s computerized connection to the California DMV registration database.
Applicant shall submit two consecutive annual reports (on District form) which shall commence approximately one year from the purchase or lease date of the new vehicle. Annual reports will require basic applicant documentation of mileage, and general comments on the new vehicle’s performance and any related maintenance issues.

By signing this Certifications section, I hereby certify that all the information provided in the rebate packet, including any attachments, are true and correct; and I have read and understand the Rebate guidelines and will comply with its requirements. I also understand that the District does not endorse, or is not in partnership with any vehicle manufacturer or dealership and any such issues arising from the purchase or lease of the new vehicle is between the applicant and the manufacturer or dealership.

Name of Vehicle Owner

Title (if purchasing under a business)

Electronic Signature of Vehicle Owner (Type Full Name)

Date

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