Let’s power excellence together The road to your electrified future begins now. Help us get to know you (and your project), and we’ll be in touch to discuss customized approaches to tackling your clients’ electrification needs. First Name*Last Name *Business Email *Phone Number *Company Name *Company Role *InternAssociateManagerSr. ManagerDirectorExecutiveFounder/OwnerI am interested in *Hosting Charging StationsOwning a Charging NetworkBoth Owning and Hosting Charging StationsI am interested in adding charging to *1-4 Properties5-10 Properties11-15 Properties16+ PropertiesI am interested in learning about National Electric Vehicle Incentives (NEVI) Program * 1 YesNoEV Charging Infrastructure Project Budget has been Approved *YesNoCountryUnited StatesCanadaDesired Charging Station Address*Note: We do not accept residential home locations through this form.City *State *Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Code*Desired DC Fast Charger Count and Parking Spot Availability * 0-7 8-10 11-15 16-20 21-25 26+ Property Type *RetailRestaurantHospitality/HotelCoffee ShopFast Casual RestaurantGovernmentConvenienceWorkplaceMixed UseOther Please select at least one of the following options Additional Location Details *RetailFood and BeveragesPublic RestroomsEntertainmentGroceryFueling Center24/7 Customer AccessibilityGated Parking LotCustomers Pay for ParkingHigh-traffic locationHighway ProximityResidentialRuralRelationship to Property * Own Lease Franchise Additional Property Notes * Send me news and marketing offers from Electrify America via telephone calls and text messages at the phone number provided. I understand such calls and texts may be made using an automated dialing system and that my consent to receive such calls and texts is not required as a condition of making a purchase. Click here for Electrify America's Privacy Statement. Error:
