subject_line
EV Charger Install Work Sheet
First Name
*
Last Name
*
Street Address
*
Address Line 2
City
*
State
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
North Carolina
New Mexico
New York
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Washington DC
Zip Code
*
Phone Number
*
Email Address
*
Have you received your charger?
*
Yes
No
Would you like us to provide your Wall charger
*
Yes
No
Type of Charger
*
NEMA 14-50
LEVEL 2 Hardwired Charger
Charger Type
*
Wall charger
Nema 14-50 outlet
Make/Model of Vehicle
Type of Home
*
Location of your Main Electrical Panel
*
Desired location of Charger
*
Garage Size (1,2,3 Cars)
*
Distance of charger from Electrical Panel in feet
*
Will your wall charger be on the same wall as your Electrical Panel?
*
What is the size of your main Breaker? It will be listed the main breaker
60 amp
100 amp
200 amp
400 amp
Other
How many electrical panels does your home have?
*
One
Two
Three
Type of Heat
*
Electric
Gas
Potential route to run the wire?
*
Foundation of Home
*
Crawlspace
Slab
Basement
If you have a basement, is it unfinished?
Yes
No
Yes, Has drop ceiling
Yes, has finished ceiling
Other
Other
Name of your power provider? Please specify if you are Duke Energy or Duke Progress Energy
*
Picture uploads for load Calculations
Close picture of Main breaker Electrical Panel (example on right)
*
Picture of desired location of the charger (example is on the right)
*
Picture of main panel from 10 to 15 ft. away (example on right)
*
Picture of Outdoor Meter/Service
Additional Pictures - Up to 3 Files