EVSE - Request for Quote -
Electric Vehicle Supply Equipment / Customer Information
Customer and Installation Site Information
First Name
*
Owner
Last Name
*
Owner
E-mail
*
Phone Number (Cell preferred)
*
-
Area Code
Phone Number
Please confirm your installation address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
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The Bahamas
Bahrain
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Belarus
Belgium
Belize
Benin
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Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
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Burkina Faso
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Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
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Cook Islands
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Cote d'Ivoire
Croatia
Cuba
Curaçao
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Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
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Falkland Islands
Faroe Islands
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Finland
France
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The Gambia
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Mali
Malta
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Mayotte
Mexico
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Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
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Nigeria
Niue
Norfolk Island
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Northern Mariana
Norway
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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
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Saint Lucia
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Samoa
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Saudi Arabia
Senegal
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Slovenia
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eSwatini
Sweden
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Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
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Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
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Turks and Caicos Islands
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Vanuatu
Vatican City
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Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
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Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Building Type
Single Family Home
Townhouse
Condo
Apartment
Duplex
Business
Commercial Building
Structure
What is the approximate square footage of your home?
Vehicle & EVSE Information
Electric Vehicle Make & Model:
Tesla Model S
Tesla Model X
Tesla Model 3
Tesla Model Y
Chevrolet Bolt EV
Chevrolet Volt
Ford Focus Electric
Volkswagen e-Golf
Honda Clarity
BMW i3
Audi E-tron Sportback
Jaguar XJ
Jaguar I-PACE
Mini E
Volvo XC40 Electric
Nissan IDS
Nissan LEAF
Audi Q6 e-tron quattro SUV
Porsche Mission E
Mercedes-Benz Generation EQ
Aston Martin RapidE
Kia Soul EV
Kia Niro
Kia Niro Plug-In Hybrid
Kia Stinger
Kia Sportage
Kia Optima
Toyota Mirai
Toyota C-HR
Toyota Prius Prime
Toyota Mirai
Toyota RAV4
smart fortwo electric drive
Hyundai Kona
Hyundai Ioniq EV
FIAT 500e
Other
Vehicle Delivery Date:
-
Month
-
Day
Year
Date
What is your daily driving distance?
Your Installation Preferences
Type of EV Outlet/Charger:
NEMA 14-30
NEMA 14-50 (Tesla Mobile Connector - with car)
NEMA 14-50 (Clipper Creek or Juice Box)
NEMA 6-50 (Charge Point)
Wall Connector (Tesla unit $500)
Multi Wall Connectors (Load Sharing)
Where do you want to install charging? The best location is on a wall near the driver's side tail light of the vehicle. Our installation crew will work with you on the day of install to confirm this location.
Garage inside on Left
Garage inside on Right
Garage outside on Left
Garage outside on Right
Other
Take a wide photo shot of the wall where you'd like charging installed including the floor up for context.
Browse Files
Here's an example of how to take the required pictures: https://www.dropbox.com/sh/e0nzdef8tmgyscs/AACXYKfgLUC0GaZwvOqhBx0ka?dl=0
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What is the approximate distance between your main electrical panel and your desired charging location?
For aesthetic purposes, the wiring can be hidden inside your walls. It may involve multiple home visits to patch and paint for an additional charge (typically +$500, up to $1000). Would you like to hide the conduit?
Yes
No
Please share any additional notes on your location preferences:
Your Home Electrical System Setup
Does your home have a backup battery system or generator?
Yes
No
1. Photos of Main Service Panel
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1. Photo of main service panel with door open showing breakers and pic of sticker.
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Main Panel Amperage (Utility Meter service - Outside house):
100A
125A
150A
200A
400A
Other
Location of (Utility Meter) Main Service Panel (Facing House):
Attached to Garage on Left
Attached to Garage on Right
Back of house on Left
Back of house on Right
Front of house on Right (not attached to garage)
Front of house on Left (not attached to garage)
Other
2. Photos of all Sub-panels
Browse Files
2. Photo of all sub-panels, if any, with door open showing breakers and pic of sticker
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Desired Install Date:
-
Month
-
Day
Year
Date
Desired Installation Time:
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
3. Draw simple site map sketch
Browse Files
3. Draw a simple site map sketch showing relationship of main and sub-panels to desired location for EV Charger installation.
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Special Notes: Anything Else We Should Know
Please share any other notes on your charging installation
Submit / Print Form
Submit Form
Print Form
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