RESIDENTIAL EV CHARGER INSTALLATION SURVEY FORM
Copyright 2025 © Electrify EVSE. All rights reserved
INSTALL TEAM CONTACT INFORMATION
Any question, Contact 1-888-822-EVSE (3873) / 770-633-0591
STEP 1: HOME OWNER/CLIENT INFORMATION
Please complete all entries
CUSTOMER'S FULL NAME
*
First Name
Last Name
1. Home Owner/Client Phone Number (BEST contact #)
*
Please enter a valid phone number.
2. Email of the Home Owner/Client
*
example@example.com
3a. Street Address of the Installation Site
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
3b. Client Address If Different from Installation Site
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
4. Please acknowledge that you have read and understood the "SAVE TIME & MONEY BY PLANNING AHEAD" Notice
*
Please Select
I have read and understood the IMPORTANT NOTICE.
5.Standard installation includes up to 10 feet of wiring from your electrical panel to the charger location. If more than 10 feet is needed, extra charges may apply. (The Pro and Lite EV Chargers come with built-in cables that are 24 feet long, which should be enough to reach your vehicle once the charger is installed.)
*
Please Select
I have read and understood that the longer cabling from panel to charger location can result in additional out of pocket expense.
6. Does This Property Require a City Permit to Install EV Charger?
*
Please Select
1. Yes, and I (the Customer) will apply for the permit
2. No, Permit is not required
3. Not Sure - Please help with research
STEP 2: EV, EVSE, INSTALL SITE INFORMATION
To be completed by the homeowner/client: Please provide accurate and factual information to ensure precise quotations.
1a. Description of EV
Year of the EV
Manufacturer of EV
EV Model
2. EV Charger Information
*
Requested Information
Comments/Notes
EV Charger Manufacturer
Model Number
Power Output (in kW)
3. Does Property Require Gate Code
*
Please Select
Yes
No
4. Garage/Parking Type (multiple garages?, leave notes)
*
Please Select
One Car Garage
Two Car Garage
Three Car Garage
Outdoor/Carport
Information not available
5. Preferred Parking Orientation
*
Please Select
Front In
Back In
Not sure / Information not available
6. Location of Electrical Panel Box
*
Please Select
Basement
Garage
Utility room
Exterior wall (for older homes facing the street)
Other locations: Storage rooms, Entryways, Hallways, Under staircases, Kitchen pantries, and Utility closets.
N/A: Not Able to Find Electrical Panel
Important Information
7. Distance between Electrical Panel to EV Charger
*
Please Select
<= 10ft between Electrical Panel and Charger
10ft < x <= 20ft between Electrical Panel and Charger
20ft < x <= 30ft between Electrical Panel and Charger
30ft < x between Electrical Panel and Charger
Not sure / Unable to Provide Distance
Provide Best Estimate
8. Additional Information/Instructions (Preferred Contact Time, Entry Gate Code, Parking Details, and Other Relevant Notes)
STEP 3: PICTURE SECTION
Please capture clear and high-resolution photos by setting your camera to the highest resolution.
1a. Home from drive way entry and garage.
*
Browse Files
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Choose a file
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of
1b. Electrical panels, breakers, and transformers.
*
Browse Files
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of
1c. Location of where you want the EV Charger to be installed (multiple angles - at least 4 pictures)
*
Browse Files
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of
1d. Other Pictures Considered important or hazard
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Save Entries & Continue Later (Click "Skip Create an Account")
Final Submission
Click to Reset (Clears All Entries)
IMPORTANT NOTICE ON "SAVE ENTRIES" & "FINAL SUBMISSION"
"FINAL SUBMISSION": Click this button only to submit the completed Installation Request Form to the Install Team. "SAVE ENTRIES": Use this button to save your progress. DO NOT CREATE AND ACCOUNT. Go to bottom and Click "Skip Create an Account". Or, copy the provided link and send to yourself to complete the survey later. "CLICK TO RESET": This will erase all data and references to previous cases, allowing you to start fresh.
Copyright 2025 © Electrify EVSE. All rights reserved
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