Electric Vehicle Charging Incentive Application EV Commercial and Municipal Charging Incentive Application Section A: MEMBER INFORMATIONBusiness Name (as it appears on NHEC bill) * Required Contact Person * Required First Last Title * Required Mailing Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone * RequiredEmail * Required Member Account Number * Required Meter Number: * Required How many hours per week is your business open to the public? Additional Information How did you hear about this program?Select oneAdvertisement inserted in my billCar dealershipContractorEmailInternet search (Google, Bing, Yahoo)Event (car show, tradeshow)Friend/ColleagueNHEC newsletterNHEC representativeNewspaperPostal mailSocial media (Facebook, Twitter, LinkedIn)OtherPlease tell us how you first heard about the charger incentive program.Section B: INSTALLER INFORMATIONInstaller's Name * Required Contact Person * Required First Last Mailing Address * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email * Required Phone * RequiredSection C: INSTALLATION DETAILSPlease upload site diagram where EV charger will be installed * RequiredMax. file size: 1 GB.Project Address ( where EV will be installed) * Required Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Proposed Project Start Date - must be mm/dd/yyyy format MM slash DD slash YYYY Circuit Voltage serving charger Circuit breaker poles (2/P, 3/P) Please upload any installation documentation.Max. file size: 1 GB.Section D: SignatureUntitled First Choice Second Choice Third Choice Terms and Conditions * Required Yes I have read and understood all materials, including the PhoneThis field is for validation purposes and should be left unchanged.