Commercial EV Charging Station Interconnection Form
Applicant/Company Information
Company Name
Contact Name
Phone Number
Email Address
Installation Address
Street Address
City
State
ZIP Code
Site Details
Site Owner Name
Site Owner Phone
Site Description
EV Charging Station Details
Number of Chargers
Charger Manufacturer
Charger Model
Output Rating (kW)
Mount Type
Wall Mount
Pedestal
Connector Type(s)
Electrical Service Information
Existing Service Type
Single Phase
Three Phase
Service Voltage
Service Capacity (Amps)
Electrical Contractor Name
Contractor Phone
Contractor License #
Supporting Documents
Site Plan Upload
Electrical One-Line Diagram Upload
Additional Notes