PON 2301 Electric Vehicle Supply Equipment Demo pre-application Questionnaire.

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* 1. Please provide the following contact information:

Name: *

Company: *

Address: *

Address 2:

City/Town: *

State: *

ZIP: *

Country:

Email Address: *

Phone Number: *

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* 2. Please choose the type of EVSE installation and evaluation locations you are seeking funding for:

Public Locations: Supermarkets, Malls, retail outlets, train stations, hotels, restaurants, parking garages/lots

Private Business Locations where employees will use EVSE for personal vehicles, townhouse communities or large apt, condo or rental communities

Business locations for use by business-owned fleet vehicles

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* 3. What is the approximate number of EVSE's are you requesting funding for?

50+

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* 4. How many total vehicles currently park at your facility(ies)?

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* 5. How many separate locations are you planning to install EVSE's at?

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* 6. Please describe your hours of operation.

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* 7. Are you currently working with any EVSE equipment vendors or installers?

Yes

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* 8. If so, please list the vendor company and contact.

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* 9. Do you currently have any EV's that charge at your location?

Yes

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* 1. Please provide the following contact information:

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* 2. Please choose the type of EVSE installation and evaluation locations you are seeking funding for:

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* 3. What is the approximate number of EVSE's are you requesting funding for?

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* 4. How many total vehicles currently park at your facility(ies)?

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* 5. How many separate locations are you planning to install EVSE's at?

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* 6. Please describe your hours of operation.

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* 7. Are you currently working with any EVSE equipment vendors or installers?

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* 8. If so, please list the vendor company and contact.

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* 9. Do you currently have any EV's that charge at your location?

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* 10. If so, how many?