United EV Enrollment Form

Account Information

Account Number

First Name on Account

Last Name on Account

Service Address

Address 2

City/Town

State

ZIP/Postal Code

Phone Number

Confirm email

Enrollment Information

Preferred Date of Charger Installation

Please select a date between Monday - Friday. Weekend service unavailable.

Select Time of Day

Where Will EV Charger Be Located?

EV Make

EV Model

Select Residential Rate Option

Select Charging Schedule:

Upload Photo of Installed NEMA 14-50 Outlet

One file only.
100 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, jpg, jpeg, png.

United EV Program Agreement

Enrollment in the United EV Charging-as-a-Service Program is contingent upon signing the program agreement. Please review and sign the program agreement below.

Program Agreement

I have read and agreed to the United EV program agreement.

I have a NEMA 14-50 outlet installed by a certified electrician at this location. The charger pigtail is 12 inches so the charger will be placed adjacent to the outlet.

Click here to apply for our make-ready wiring rebate.

I acknowledge that the charger will be connected to my home Wi-Fi service and that a signal is available at the location where the charger will be installed.

I have the consent of the property owner to enroll in United EV at this location.

Please tell us where you purchased your EV.

Signature & Authorization

Signature

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United EV Enrollment Form