Electric Vehicle Charging Incentive Application

2018 EV Commercial and Municipal Charging Incentive Application

Section A: MEMBER INFORMATION
Business Name (as it appears on NHEC bill) * Required
Contact Person * Required
First Last
Title * Required
Mailing Address * Required
Street Address Address Line 2 City State ZIP Code
Phone * Required
Email * 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?
Please tell us how you first heard about the charger incentive program.
Section B: INSTALLER INFORMATION
Installer's Name * Required
Contact Person * Required
First Last
Mailing Address * Required
Street Address Address Line 2 City State ZIP Code
Email * Required
Phone * Required
Section C: INSTALLATION DETAILS
Please upload site diagram where EV charger will be installed * Required File upload
Project Address ( where EV will be installed) * Required
Street Address Address Line 2 City State ZIP Code
Proposed Project Start Date - must be mm/dd/yyyy format
Circuit Voltage serving charger
Circuit breaker poles (2/P, 3/P)
Please upload any installation documentation. File upload
Section D: Signature
Terms and Conditions * Required
- Yes
I have read and understood all materials, including the Terms and Conditions
Member Signature * Required
Date - must be mm/dd/yyyy format * Required
Phone
This field is for validation purposes and should be left unchanged.

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Section A: MEMBER INFORMATION