Requestor's Full Name
*
First Name
Last Name
Requestor's Email
*
example@example.com
Requestor's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Company Name
*
EV Charging Site Address (Non-residential Only)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Site Contact Name
*
First Name
Last Name
Site Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Chargers Manufacturer(s) [if Known]
Charger Model(s) [if Known]
Charger Serial Number(s) [if Known]
Comments
Scope of Work
Select All That Apply
Cable Swaps
Ev Charger Derating
Sim Card Swaps
Credit Card Readers
Onsite OEM Support for Technician
Other
Charger Swaps
Cable Length Needed
Brand of Cable Needed
Cable Configuration - NACS, CCS1, GPT, CHAdeMO
EV Charger Derating - Do you need your charger to be derated?
Yes
No
Sim Card Swaps - Will the sim cards be shipped by the OEM?
Yes
No
Credit Card Reader - Do you need a credit card reader installed?
Yes
No
Onsite OEM Support for Technician - Please provide supporting OEM documentation
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