Free Application Support Request for ChargeON Program

Name*

First NameLast Name

Phone/Cell*

E-mail*

Prefered mode

E-mailPhone/Cell

Project Site*

Street Address

Street Address Line 2

City

Number of Electric Vehicle (EV) Chargers*

Expected Date*

Please select all applicable types of support.

By clicking the submit button, I agree to Privacy, Data Collection & Waiver Notice*

rivacy, Data Collection & Waiver Notice&#13;&#10;&#13;&#10;By submitting this form, you consent to the collection, use, and storage of your personal information by Elocity Technologies Inc. and its affiliates (“Elocity”) for the purposes of assessing and processing your EV charging request, coordinating installation, providing services, and communicating with you regarding your application.&#13;&#10;&#13;&#10;Your information (including your name, contact details, property information, parking details, and installation-related data) will be used solely for these purposes and may be shared with authorized service providers as necessary to fulfill your request. Elocity complies with all applicable privacy laws, including the Personal Information Protection and Electronic Documents Act (PIPEDA) and the Freedom of Information and Protection of Privacy Act (Ontario). Your data will be securely stored and will not be sold or disclosed for unrelated marketing purposes.&#13;&#10;&#13;&#10;By signing or submitting this application, you:&#13;&#10;&#13;&#10;Acknowledge and consent to Elocity’s collection, use, and disclosure of your personal information as described above.&#13;&#10;&#13;&#10;Confirm the accuracy of all information provided and accept responsibility for any inaccuracies or omissions.&#13;&#10;&#13;&#10;Waive and release Elocity and its affiliates from liability for delays, disruptions, or issues that arise due to incomplete, inaccurate, or incorrect information you provide.&#13;&#10;&#13;&#10;Understand that installation and service timelines may depend on factors outside of Elocity’s control (including building approvals, utility requirements, or equipment availability), and agree that Elocity is not liable for delays beyond its reasonable control.&#13;&#10;&#13;&#10;You may request access to, correction of, or withdrawal of your personal information at any time, subject to legal and contractual requirements, by contacting our Privacy Officer at privacy@elocity.com&#13;&#10;. For full details, please review our Privacy Policy.&#13;&#10;&#13;&#10;By signing or submitting this form, you confirm that you have read, understood, and agree to the terms of this notice and waiver.