ALPHA OMEGA COMMERCIAL FORM: INSTALL AND SERVICE
Copyright 2025 © Electrify EVSE. All rights reserved
Section A. Customer/Site Information Section
To Client: For Accuracy, please complete as accurately as possible
1. Business / Commercial Name
*
a. Site Contact Name
*
b. POC Phone Number
*
c. Site Contact Email
*
Electrify EVSE Email
No Need to Fill-out
2. Site Address (Must Complete)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
2. Business Address (If Different from Site Address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Section B. Project Specific Information
1. Type of Work Required (Choose Multiple If Applicable)
*
New Installation
Board Replacement
Cable Management
Charger Replacement
Commission
Configuration
Cord Replacement
Firmware Update
Incoming Power
Lockbox
Screen Replacement
SIM Card Swap
Troubleshoot
Total Removal
Other (desc below)
2a. Current Charger Information (If None @ Site, just choose "No Charger Onsite" on first line to pass to next section)
*
Status
Manufacturer
Model Number
Serial Number
Charger #1 @ Site
Charger @ Site
No Charger Onsite
Charger #2 @ Site
Charger @ Site
No Charger Onsite
Charger #3@ Site
Charger @ Site
No Charger Onsite
Charger #4 @ Site
Charger @ Site
No Charger Onsite
Charger #5 @ Site
Charger @ Site
No Charger Onsite
Charger #6 @ Site
Charger @ Site
No Charger Onsite
Charger #7 @ Site
Charger @ Site
No Charger Onsite
New Charger Information (For New Installation ONLY)
Manufacturer
Model Number
Charger Mounting Type
New Charger #1
Dual Pedestal
Single Pedestal
Pole Mounted
Wall Mounted
Other (Describe Below)
New Charger #2
Dual Pedestal
Single Pedestal
Pole Mounted
Wall Mounted
Other (Describe Below)
New Charger #3
Dual Pedestal
Single Pedestal
Pole Mounted
Wall Mounted
Other (Describe Below)
New Charger #4
Dual Pedestal
Single Pedestal
Pole Mounted
Wall Mounted
Other (Describe Below)
New Charger #5
Dual Pedestal
Single Pedestal
Pole Mounted
Wall Mounted
Other (Describe Below)
New Charger #6
Dual Pedestal
Single Pedestal
Pole Mounted
Wall Mounted
Other (Describe Below)
New Charger #7
Dual Pedestal
Single Pedestal
Pole Mounted
Wall Mounted
Other (Describe Below)
3. Breaker Panel Information
*
Panel Location
Distance from Panel to Charger (in feet(s))
Electrical Panel
Garage
Basement
Outer Building
Utility Room
Other
4. Work Scope/Task Requirement
*
5a. If a Third Party Vendor/Software Co is involved, Please indicate ?
Please Select
ChargeTronix/Tellus
Zerova/Phihong
Tritium
Other Partners
N/A - No Third Party
DO NOT SKIP THIS QUESTION: Your Service could be Rejected!
b. Name of Agent
c. Agent Phone Number
d. Agent Email
**This email must be the Third Party manager's email.
7. Additional Comments Regarding the Project Case
Write down any potential issues you noticed at the Job Site, with the EV Charger(s), and with the condition(s) that could cause any issues.
Section C. ONLY Upload Good Quality Pictures
IMPORTANT: PLEASE UPLOAD AS MANY PICTURES AS POSSIBLE
1. IMPORTANT: Pictures of "Existing" Charger(s). ****Must Display Clear & Readable Serial Numbers****
Browse for Pictures
Drag and drop files here
Choose a file
DO NOT SKIP THIS QUESTION: Your Service could be Rejected!
Cancel
of
2. IMPORTANT: Pictures of "Breaker Panel". ****Must Display Clear & Readable Descriptions****
Browse for Pictures
Drag and drop files here
Choose a file
DO NOT SKIP THIS QUESTION: Your Service could be Rejected!
Cancel
of
3. IMPORTANT - PICTURES OF THE WHOLE CHARGER SITE: 2 Pictures (Wide view) of site.
Browse for Pictures
Drag and drop files here
Choose a file
Cancel
of
4. OTHER HELPFUL PICTURES
Browse for Pictures
Drag and drop files here
Choose a file
Cancel
of
Signature and Submit Section
IMPORTANT: Signed by manager who is managing the JOBs
Please Sign to authenticate information provided
*
Save Entries (To Continue Later)
Submit Final Request Form (By Mgmt. Only)
Submit Final Request Form (By Mgmt. Only)
Clear All Answers
IMPORTANT NOTICE ON SUBMISSION
The "Save Entries" button will allow a user to "Save" and forward a link to an email recipient for the Service Request Form to be completed at a later time (for yourself or for the management's review). The "Final Service Request Form" button should only be used by the Management to submit the Final Service Request Form to Electrify EVSE after a review. ***** Click on "Clear All Answers" to erase all data/references to previous JOBs and start from the beginning.*****
Copyright 2025 © Electrify EVSE. All rights reserved
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