Agency template

EV Charging Station

Application Intake Form

Zero Commitment to Apply!

Amazing Opportunity if your Business Qualifies!

Have you watched the presentation? *

Yes

No

Not Sure

Legal Name of Business *

Do you have multiple locations? If "yes" submit 1 location & add all other site location addresses in the Notes Section

Yes

No

Maybe

Business Address *

City *

State *

Zip code

Contact First Name *

Contact Last Name *

Is this contact the decision maker? *

Yes

No

Unsure

What is your title?

Contact Phone *

Contact Email *

Does the business own the property? *

Yes

No

Unsure

Which product are you interested in?

EV Charging Station

Electric Generation

Both

Take a picture of each page of your power bill & upload it here OR sign into your utility online (by copy & pasting this URL): https://app.thesuperconnect.com/request/electric/e95b77a8-a669-4cfd-ac1f-09c6ee4c6e2f

Notes

Who referred you? *

I Consent to Receive SMS Notifications, Alerts & Occasional Marketing Communication from company. Message frequency varies. Message & data rates may apply. Text HELP to (530) 760-7974 for assistance. You can reply STOP to unsubscribe at any time.