EV Smart Charging Form_

How did you hear about the program?
Farmer's MarketWMGLD WebsiteNewspaperOther

Your Name (required)

WMGLD Customer Number

Installation Address (please do not list P.O. Box #)

Street Address

Home Phone

Cell Phone

Your Email (required)

Please attach requested documents below (PDF or JPG accepted)

Receipt for Chargepoint Home Flex Charger (6MB max.):

Proof of EV Ownership (6MB max.):

Copy of signed On-peak Charging Agreement (6MB max.):

By submitting this form, I certify that I have purchased an electric vehicle and I am an electric customer of WMGLD. I am providing the requested information solely to be eligible to receive a rebate through this program and request that the personal information supplied by me be treated as confidential.

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