IRS PHEV/EV TAX CREDIT FORM

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

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.Format: (000) 000-0000.
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

Dealership Employee

First NameLast Name
Dealership Employee Signature
Should be Empty: