Name*

Email address*

Company name

Phone number*

Address Line 1*

City

State / Province / Region

Postal Code

Country*

Did you purchase a vehicle already?* NoYes

If you have already purchased a vehicle, please state vehicle Make/Model

Property Electrical Supply?
*Single PhaseThree Phase

Vehicle Type*
Full ElectricPlug-In Hybrid

Property Load?* 30 Amps32 Amps40 Amps60 AmpsDon't Know

Please state the distance from meter box to the location you would like to install the EV Charger (If Known)

Please upload images from your meter box and the location you would like the EV charger to be installed

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