Tesla Wall Charger

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone * This field is required.

4

Is the wall charger in a house or business* This field is required.

House Business

5

What type of house* This field is required.

Single Story Double Story

6

Is you fuse board less than 15 meters from wall charger location?* This field is required.

YESNO

7

How far is the board?

20 meters

30 meters

40 meters

8

Is you charger location clear and not obstructed by a path of travel?* This field is required.

YESNO

9

Please upload a clear photo of you Fuse Board, Area where you want the charger to be installed and Premises * This field is required.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

10

Any other information you would like us to know?

11

Since you are a business customer, we will contact you for more information, Thanks!