First name
Last name
Email
Phone
Company Name
Type of Installation: (For Home Installation)
Home Installation
Commercial Installation
Have you purchased an EV charger?
YES
NO
Type of EV Charger:
LEVEL 1
LEVEL 2
LEVEL 3
Type of Home:
HOUSE
APARTMENT
CONDO
Distance from the Electric Panel to Installation Spot (in feet):
Type of Business: (For Commercial Installation:)
Retail
Office Building
Apartment Complex
Industrial
Number of Chargers Needed:
Type of EV Chargers:
LEVEL 2
Level 3 (DC Fast Charger)
LEVEL 3
Electric Panel Distance (Approximate Feet):
Additional Information or Special Requests:
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