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Medium-Duty and Heavy-Duty Zero-Emission Vehicle Grant Program Reimbursement
Please fill out and submit this form to request reimbursement for the Medium-Duty and Heavy-Duty Zero-Emission Vehicle Grant Program.
5
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1
Grant Number
*
This field is required.
You can find this information in the Grant Agreement.
It should be of the form
YYYY-XX-528S1
(for AOI 1: On-Road Grants) OR
YYYY-XX-529S1
(for AOI 2: Off-Road Grants)
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2
Grantee Name
*
This field is required.
You can find this information in the Grant Agreement
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3
Email
*
This field is required.
Any questions we have about this reimbursement request will be sent to this email
example@example.com
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4
Reimbursement Request Invoice
*
This field is required.
This must be on the Grantee letterhead, and must include the Grant Number, and Grantee's Federal Identification Number.
A template can be found
here
.
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: 10.6MB
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5
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Should be Empty:
Clone of MHD Reimbursement
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