Full Name

Company/Organization Name

Email Address

Phone Number

Site Address

Type of Location
Apartment ComplexCondominiumHotelShopping CenterTransportation HubFleet DepotRestaurantGas StationPublic Parking LotMunicipality / City PropertyAirportHospitalCar DealershipRental Car CompanyTruck StopOther (Mention Below)

How Many EV Charging Stations Are You Considering?
1-23-56-1011+

How Will the Chargers Be Used? (Select all that apply)
Public Use (Customers/Visitors)Employee UseTenant/Resident UseFleet ChargingGovernment/Municipality UseOther (Mention Below)

Who Will Cover the Installation Costs?
Our business/organization will purchase and own the chargersWe prefer a revenue-sharing model with UpVolt EV covering installation costsNot sure yet, need more information

Do You Need Charger Management Services?
Yes, we want UpVolt EV to manage and maintain the chargersNo, we will manage the chargers ourselvesNot sure, need more information

Are There Existing Electrical Panels or Infrastructure for EV Charging?
YesNoNot Sure

Estimated Power Availability (if known)

Preferred Installation Timeline
ASAP1-3 months4-6 months6+ months

Additional Comments or Questions

Upload Photos or Site Plans (Optional - image,pdf,docx)