Electric Vehicle Charging Subsidy Pre-Assessment Form
Full Name
Email Address
Phone Number
Installation Address
Type of Residence
Single-Family House
Apartment/Condo
Other
Do you own or rent your residence?
Own
Rent
Are you currently an electric vehicle owner?
Yes
No
If yes, please specify make and model
Preferred Charger Type
Level 1 (120V)
Level 2 (240V)
Unsure
Other relevant details or comments