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734-212-2020
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Home
About
Services
Technologies
Incentives
Resources
Contact
Home
About
Services
Technologies
Incentives
Resources
Contact
Get a Free Consultation
Home
About
Services
Technologies
Incentives
Resources
Contact
Get a Free Consultation
Get a Free Consultation
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Residential Intake Form
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Residential Intake Form
FULL NAME
DATE
ADDRESS
EMAIL
PHONE
VEHICLE INFORMATION
Note: Please fill out this section if your installation is for a specific model vehicle.
Year, Make and Model
Do you have an EV Charger?
Yes
No
EV Date Delivery
Dealership Sales Agent (optional)
HOME DESCRIPTION
Home Square Ft
Attic Access?
Yes
No
Basement?
Yes
No
Electric Utility Co?
Gate Code (Community or Private)
Yes
No
Parking
Preferred Garage Spot
Preferred Garage Spot
APPLIANCES
HVAC Units #
Dryer Type (gas or electric)
Stove/Range (gas or electric)
AMENITIES
Pool
Yes
No
Outdoor Hot Tub
Yes
No
Solar Panels
Yes
No
Interested in Solar Panels?
Yes
No
ADDITIONAL INFORMATION
Interested in Affordable Payment Options? 0% interest available over 18 months
Yes
No
Additional Information or Comments
UPLOAD PHOTOS
Photo of Home from Street
Photo of Garage or Charger Location
Photo of Garage Interior
Overview Photo of Main Electrical Panel Placement
Close Up Photo of Main Electrical Panel
Overview Photo of Electrical Sub-Panel Placement
Close Up Photo of Electrical Sub-Panel
Photo of Ideal Charger Location
IF YOU HAVE ANY ADDITIONAL COMMENTS OR INFORMATION THAT WE NEED TO KNOW PLEASE WRITE IT DOWN BELOW:
Submit Request
