Homeowner EV Charger Evaluation Form

1
Your name* This field is required.
First Name
Last Name
2
Email* This field is required.
3
Phone number* This field is required.
Please enter a valid phone number.
4
Home address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
Do you have an electric vehicle (EV)?
Yes
No, but planning to purchase soon
No
6
What EV do you have (or plan to buy)?
7
Where will you park and charge?Pick all that apply.
Garage (Attached)
Garage (Detached)
Carport
Driveway
Condo / Apartment
Other
8
Where would you like the charger?
9
Where is your main electrical panel?
Garage
Basement
Outside (exterior wall)
Other / Not sure
Other
10
How is your kitchen set up for cooking?* This field is required.
One-piece range (stove top and oven in one unit)
Wall oven(s) + separate cooktop
Wall oven only
Cooktop only
Not sure
11
What powers your range?* This field is required.
Electric (coil, glass top, or induction)
Gas or propane
Dual-fuel (gas top, electric oven)
Not sure
12
How many wall ovens?* This field is required.
1
2 (double or stacked)
Not sure
13
Wall oven fuel* This field is required.
Electric
Gas or propane
Not sure
14
Cooktop fuel* This field is required.
Electric or induction
Gas or propane
Not sure
15
Clothes dryer* This field is required.
Electric
Gas or propane
Heat-pump or ventless electric
No dryer
Not sure
16
Water heater* This field is required.
Electric tank
Heat pump water heater (fan on top)
Electric tankless (on the wall)
Gas or propane tank
Gas or propane tankless
Heated by the boiler (oil or gas)
Not sure
17
How do you heat your home?* This field is required.Pick all that apply.
Oil boiler or furnace
Gas or propane furnace
Gas or propane boiler
Ducted heat pump (central)
Ductless mini-splits
Electric baseboard or wall heaters
Electric radiant floor
Geothermal
Wood or pellet
Not sure
18
About how many rooms have electric baseboard?
Please Select
Please Select
1-2
3-5
6+
Whole house
19
Cooling* This field is required.Pick all that apply.
Central A/C
Heat pump (same as heating)
Ductless mini-splits
Window units only
None
Not sure
20
How many outdoor A/C or heat pump units?* This field is required.
Please Select
Please Select
0
1
2
3
4+
Not sure
21
Is your water from a well?* This field is required.
Yes, well pump
No, town water
Not sure
22
Do you have any of these?* This field is required.Pick all that apply.
Hot tub or spa
Pool pump
Pool heater (electric or heat pump)
EV charger already installed
Sauna
Sump pump
Sewage or ejector pump
Extra fridge or freezer
Snow-melt or roof de-icing cable
Workshop tools, welder, or kiln
Electric fireplace insert
None of these
Not sure
23
How many garage door openers?
Please Select
Please Select
0
1
2
3
4+
24
Is your basement finished?
Yes
Partly
No
No basement
25
What number is printed on your main breaker?* This field is required.The big breaker, usually at the top of the panel. No big breaker in the panel? It is probably outside next to the meter.
60
100
125
150
200
400 (or two 200s)
No main breaker in the panel (it is outside at the meter)
I have fuses
Cannot read it / Not sure
26
Is there a second breaker panel (subpanel) anywhere?* This field is required.
Yes
No
Not sure
27
Where is the subpanel?For example: garage, barn, pool house.
28
Do power lines come in overhead or underground?
Overhead (wires from a pole to the house)
Underground
Not sure
29
Electric company* This field is required.
Eversource
United Illuminating (UI)
Town-owned utility
Not sure
30
Can you share your last 12 months of electric usage?
Yes, I will upload bills
Yes, I can log in with you
No
Not sure
31
Upload electric bills or usage screenshotsPDF or screenshots are fine. Skip if you prefer.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
32
Have you added any big electric equipment in the last 12 months?* This field is required.For example: heat pump, EV charger, hot tub, electric water heater.
Yes
No
Not sure
33
What was added, and about when (month and year)?
34
Do you have a generator now?* This field is required.
No
Portable
Standby (permanently installed)
Not sure
35
Portable generator size (running watts on its label)
Please Select
Please Select
Under 5,000 watts
5,000 to 7,500 watts
7,500 to 10,000 watts
Over 10,000 watts
Not sure
36
How do you hook up your portable generator today?
Extension cords
Outdoor inlet box with an interlock or transfer switch
Not set up yet
Not sure
37
Standby generator brand and size (kW)
38
Standby generator fuel
Natural gas
Propane
Diesel
Not sure
39
What do you want running in a power outage?* This field is required.
Whole home
Essentials (fridge, heat, well pump, some lights, Wi-Fi)
Essentials plus A/C
Not sure
40
Propane tank size
Please Select
Please Select
No propane
100 lb
120 gal
250 gal
500 gal
1,000 gal
Not sure
41
Panel photosNext we will ask for a few photos of your electrical panel. They let us answer without a visit.
I cannot get panel photos right now. Text me instead.
42
EXAMPLE: MAIN Electrical BreakerUsually inside the main panel, or outside next to the meter.
43
Photo of your main breakerGet close to the big breaker, usually at the top, and photograph the number on its handle straight on. Turn off the flash if there is glare. No big breaker in the panel? It is probably outside next to the meter; photograph that one.
Drag and drop files here
Select files to upload
Max. file size: 25.0MB
Tap to take a photo or pick from your library.
Cancelof
44
EXAMPLE: Electrical Panel Photo
45
Photo of your panel from 15 ft backShow floor to ceiling, like the example above.
Drag and drop files here
Select files to upload
Max. file size: 25.0MB
Tap to take a photo or pick from your library.
Cancelof
46
EXAMPLE: Electrical Panel Breakers
47
Photo of your main panel (door open)Open the panel door and take one photo of the whole panel, then we will ask for close-ups next.
Drag and drop files here
Select files to upload
Max. file size: 25.0MB
Tap to take a photo or pick from your library.
Cancelof
48
Breakers close-up: top halfGet close enough that we can read the numbers on the breaker handles (15, 20, 30...). Turn off the flash if there is glare.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
49
Breakers close-up: bottom halfSame as the top half, for the bottom half of the panel.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
50
EXAMPLE: Electrical Panel Sticker Labeling
51
Photo of the sticker inside the panel doorThe paper or metal label with the brand, model, and amp rating, inside the door or on the side wall of the panel. Get close enough to read it. Two photos is fine.
Drag and drop files here
Select files to upload
Max. file size: 25.0MB
Tap to take a photo or pick from your library.
Cancelof
52
Electrical Wiring Pathways (Between Main Panel & EV Charger)Example Photos
53
Photos of the path from panel to charger spotWalls, ceilings, or basement along the way.
Drag and drop files here
Select files to upload
Max. file size: 25.0MB
Tap to take a photo or pick from your library.
Cancelof
54
EXAMPLE: Proposed EV Charger Location
55
Photo of the charger spot from 15 ft backShow floor to ceiling.
Drag and drop files here
Select files to upload
Max. file size: 25.0MB
Tap to take a photo or pick from your library.
Cancelof
56
EXAMPLE: EV Charger Walls
57
Photos of each wall in the charger roomStand back so we see floor to ceiling.
Drag and drop files here
Select files to upload
Max. file size: 25.0MB
Tap to take a photo or pick from your library.
Cancelof
58
Photos of any subpanels or pool panelsSame as the main panel: one photo of the whole panel with the door open, then close-ups of the breakers and the label. Skip if you have none.
Drag and drop files here
Select files to upload
Max. file size: 25.0MB
Tap to take a photo or pick from your library.
Cancelof
59
Which of these do you have?Pick all that apply.
Electric Oven
Electric Cooktop (Separate Appliance)
Hot Tub (Hardwired)
Outdoor A/C Unit (Hardwired)
None of these
Other
60
Outdoor A/C or heat pump sticker (one photo per unit)On the side of the outdoor unit there is a sticker with Model, Serial, and MCA / Max Breaker (or Max Fuse). Get close enough to read it. Skip if you have no outdoor unit.
Drag and drop files here
Select files to upload
Max. file size: 25.0MB
Tap to take a photo or pick from your library.
Cancelof
61
Indoor air handler or furnace stickerUsually on the front cover or inside the door of the indoor unit (basement, attic, or closet). Include any extra sticker that says heater kit or kW.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
62
Range or wall oven stickerPhotograph the MODEL and SERIAL number sticker (it may also show watts or kW). Range: open the oven door or the bottom drawer and look on the frame. Wall oven: open the door and look on the door frame or side trim. Skip if gas.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
63
Cooktop stickerPhotograph the MODEL and SERIAL number sticker (it may also show watts or kW). It is usually on the underside of the cooktop; look up from the cabinet below. Skip if gas or no separate cooktop.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
64
Dryer stickerPhotograph the MODEL and SERIAL number sticker (it may also show watts). Look inside the door rim or on the back panel. Skip if gas.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
65
Dishwasher model stickerPhotograph the MODEL and SERIAL number sticker. Open the door and look on the top or side edge of the inner door or tub.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
66
Refrigerator model stickerPhotograph the MODEL and SERIAL number sticker. Look inside the fridge on a side wall or the ceiling, or behind the bottom kick plate.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
67
Microwave model stickerPhotograph the MODEL and SERIAL number sticker. Open the door and look on the frame. Over-the-range microwaves sometimes have it on the bottom.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
68
Water heater stickerThe label on the side of the tank or unit showing watts or kW. Skip if gas or oil.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
69
Electric meterThe meter outside. Stand back a few feet so we see the meter and the pipe or wires going into the house.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
70
Door directory / circuit listThe list of what each breaker controls, if you have one.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
71
Generator label and inlet or transfer switchThe label on the generator frame showing watts, plus the outdoor plug box or transfer switch if you have one. Skip if no generator.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
72
Hot tub, pool, or other equipment labelsThe rating sticker on the equipment or its disconnect. Skip if none.
Drag and drop files here
Select files to upload
Max. file size: 10.0MB
Cancelof
73
Any 240V outlets near the charger spot?
Yes
No
Not sure
74
Do you already have an EV charger?No problem if not. We can supply one.
Yes
No
75
Mission Electric, LLC | Connecticut Eversource EV Incentives for 2026Learn About the Process, the Rebates, and Us!
76
Anything else we should know?
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