This document provides information about applying for incentives from the Clean Vehicle Incentive Program (CVIP) in Texas. To qualify, vehicles must be 2003 or newer models purchased or leased after August 2002 that are driven at least 75% in Texas, weigh under 10,000 pounds, and meet EPA emissions standards of Bin 1-4. Applicants must submit title documents and bills of sale. Incentives range from $1,250 for Bin 4 vehicles to $5,000 for Bin 1. The program has limited funding and applications will only be accepted when funds are available.

1. 14-126
b.
(Rev.3-03/2)
CLEAN VEHICLE INCENTIVE PROGRAM (CVIP) CLAIM
58120 Page 1 of ____
a. Tcode
CVIP MINIMUM QUALIFICATIONS
CONTACT INFORMATION
• New 2003 or later model year
• Leased or purchased on or after August 1, 2002,
Direct funding for this program was
1. Name of purchaser, or if leased, name of lessee of new motor vehicle and registered in Texas
• Gross vehicle weight of less than 10,000 pounds
reallocated during the 2003 • Driven at least 75 percent of mileage within the state.
• Certified by the U.S. Environmental Protection
2. Mailing address (Enter the address where the session of the Texas Legislature.
regular incentive is to be mailed.) Agency
PURCHASER / LESSEE INSTRUCTIONS
Copies of the following signed documents MUST be
Applications will not be accepted until sent in with this claim to the address shown below.
3. City State ZIP code • Title Application Receipt
funds are available. • Bill of Sale, or if leased, Lease Contract
4. Texas taxpayer number (if applicable) The Clean Vehicle Incentive Program has limited
funding. Payments will be suspended if the fund falls
For more information, CLICK HERE. the legislatively mandated reserve. We will
below
5. Daytime phone (Area code and number)
accept applications during periods when funds are not
available. For information on available funding,call the
fund hotline at 1-888-434-5964.
VEHICLE INFORMATION
SPECIFIC INSTRUCTIONS FOR ITEMS 7 & 8.
The label titled “VEHICLE EMISSION CONTROL
6. Vehicle identification number (VIN)
INFORMATION” (VECI) should be located under the
hood of the vehicle. It should include an alpha numeric
7. Test group number on VECI label Test Group number (Item 7). It should also include a
Bin number, which must be 1 through 4 in order to
qualify for this incentive program (Item 8).
8. Bin number (Enter value 1 - 4 from VECI label.)
BIN LEVEL INCENTIVE
4 $1,250
9. Vehicle manufacturer 3 $2,225
2 $3,750
1 $5,000
10. Vehicle model
DEALERS OR LEASING AGENTS
Retain this form on file for two years from the date
11. Vehicle model year
of purchase.
* Disclosure of your social security number is
12. Odometer reading on the date of purchase/lease
required and authorized under law, for the purpose of
tax administration and identification of any individual
PURCHASE / LEASE INFORMATION affected by applicable law. 42 U.S.C. sec
405(c)(2)(C)(i); Tex. Gov't Code secs 403.011 and
403.078. Release of information on this form in
13. Date of purchase/lease (Month, day, year) response to a public information request will be
governed by the Public Information Act, Ch. 552,
Government Code, and applicable federal law.
14. Business name of motor vehicle dealer or leasing agent
You have certain rights under Ch. 559, Government
Code, to review, request, and correct information we
have on file about you. Contact us at the address or
15. Leasing period in months (if applicable)
toll-free number listed on this form.
I certify that all information is correct, 75 percent of all miles driven in this vehicle will be in the State of Texas, and the Gross Vehicle Weight Rating is less
than 10,000 pounds.
Purchaser / Lessee signature *Social Security number or FEIN of recipient Date
I certify this sales transaction is valid and the purchased / leased vehicle has the valid Bin number to qualify for the incentive benefit.
Seller / Leasing Agent signature Printed name Daytime phone (Area code & number) Date
Return this form with supporting documents to: If you have any questions regarding the Clean Vehicle Incentive Program, you may contact the
COMPTROLLER OF PUBLIC ACCOUNTS Texas State Comptroller's office at 1-800-252-1382, toll free, nationwide. The local number in Austin
Revenue Accounting Division is 512/463-4600. If you're calling from a Telecommunications Device for the Deaf (TDD), the toll-
111 E. 17th Street
free number is 1-800-248-4099, or in Austin, 512/463-4621.
Austin, TX 78774-0100