EV Charging Station Installation Incentive Request
Applicant Information
Name/Organization
Contact Person
Email
Phone
Installation Address
Project Details
Charging Station Type
Level 1
Level 2
DC Fast Charger
Number of Chargers
Expected Installation Date
Installer (Company/Contractor)
Estimated Project Cost
Incentive Request
Requested Incentive Amount
Reason/Justification
Certification
I certify that the information provided is accurate and complete.