Electric Vehicle Charging Station Release Form

Electric Vehicle Charging Station Release Form
Please complete this form to acknowledge the release and terms of use for the EV charging station.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Vehicle Make and Model
Vehicle License Plate Number
Date of Use
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Signature
Clear
Should be Empty: