EV Charger Survey

EV Charger Estimate Form
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
1. Single Family, Multi Family, or Commercial Installation site?*
2. Own Or Rent*

OwnRent
3. Do you have a level 2 Charger already?*

Yes I have one, Or I plan on buying my ownI would like you to include the charger in the estimate
4.If you are providing the charger, what is the make and model?*
5.What Make and Model Car Did YouBuy?*
6. Where do you want the charger installed?*

Inside my garageOn the Exterior of the house/ buildingOther
7. Is your house Pre wired for an EV Charger?*

YesNoNot sure
8. What year was your house built?*

2015+2000-20151990-20001990 and older
9.Do you have any of the following (select all that apply)

Electric OvenElectric Cook TopCentral A/CPoolHot tub/SpaElectric Water heaterElectric DryerSolarExisting EV ChargerSteam Unit
10. Please upload a Picture of your main Electrical panel on the exterior of the house so I can see the Breakers and labels.*

Cancelof
11. Please upload a picture of any other electrical panels you may have so I can see the breakers and label.*

Cancelof
12. Standing back 10ft, Please upload a picture of the area you would like the Charger installed.*

Cancelof
13. Approximately how many feet from the main electrical panel is the Charger installation location?*
14. Any Additional comments or information you would like to add?
15. How did you hear about us?*
Should be Empty:

EV Charger Estimate Form