Name Account # Email Address Phone Number Service Address Mailing Address Age of Driver Average Miles Driven per week Make & Model of EV Date of Purchase Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20212022202320242025 Do you currently have a charger? Yes No If yes, what type?: How often do you charge your EV? Where is the charger located? (For example, garage) Is there a 240V dedicated circuit-NEMA 14-50 plug? Yes No Are cables able to reach the EV with slack? Yes No Would you be interested in participating in a paid pilot program for 25 DEMCO members to share EV charging data? Yes No
