Residential EV Charging Station Installation Request Form
Full Name
Phone Number
Email Address
Installation Address
City
State/Province
ZIP/Postal Code
Property Type
Single-Family Home
Apartment/Condo
Townhouse
Other
EV Make and Model
Charger Type Requested
Level 1 (120V)
Level 2 (240V)
Unsure
Electrical Panel Location
Additional Notes / Comments