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Last Name *

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Address

Address

Electric Utility Provider

Referred By: Dealership and Rep. Name

electric panel within 10ft of Preferred Installation Location?

Yes

No

Solar Panels

Yes

No

Charger Supplied By

Apex Mechanical
Customer
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Additional Information or Comments

Photo of main electric panel

Open the door and take a photo of the entire panel including the main breaker

Image of ideal charger location

Any additional images, diagrams, etc.

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