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Middlesex, NJ

201-565-2482

inquiry@volt4me.com

First Name

Last Name

Do you have a promo code?

Email

What type of property will the charging station be installed at?

Do you own your home?

Have you received permission from your Home Owners Association (HOA) or Landlord?

City

Postal / Zip code

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What is the sq ft of your home?

Where is your main electrical panel located?

is your basement finished?

Yes

No

When do you plan to receive the vehicle

Where would you like the charging station installed

Roughly how far away will the charger be located from your main electrical panel(in ft)

Will the location of the Charger and your main electrical panel share the same wall?

Yes

No

How strong is the wifi connection at the proposed location of the charger?

Srong

Weak

No signal

How many central Air units does your home have?

0

1

2

3

4

Do you have a swimming pool or hot tub?

Yes

No

Please select any ELECTRIC powered appliances you have

Electric Dryer

Electric Hot water heater

Electric Oven

Electric cooktop

Electric sauna

Electric Furnace

Electric baseboards

Electric heated floor

Other

How quickly do you this charger installed?

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