IRS PHEV/EV TAX CREDIT FORM

IRS PHEV/EV TAX CREDIT FORM
Dealership Information
Dealership Location:*
Chevrolet Taxpayer ID:

81-0837637
Dodge Taxpayer ID:

81-5190309

Buyer/Tax Payer Information
Buyer/Tax Payer Name (Hereinafter called "Buyer")*

First NameLast Name
Buyer/Tax Payer Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Buyer/Tax Payer Phone #*
Please enter a valid phone number.
Buyer/Tax Payer Email*
example@example.com
Buyer/Tax Payer SS # *

Vehicle Information
Vehicle ID Number (VIN #)*
Vehicle Battery Capacity*
Battery Voltage
Sale Date*

MonthDayYear
Date
Sale Price of Vehicle*
$27,900.00
Maximum Credit Allowable*
$3,500.00
Buyer Signature*

Clear

Dealership Employee*

First NameLast Name
Dealership Employee Signature*

Clear
Should be Empty: