Installation Request Form "*" indicates required fields Name* First Last Phone*Email* HiddenGeocoderHiddenCompany HiddenAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Address MapEV Purchased What kind of property will your charger be installed at?ApartmentTownhouse / DuplexStand Alone HouseOtherWhere is your preferred location for your EV charger?Open DrivewayCarportShedOtherHiddenOther Property HiddenOther Preferred Location Do you have space on a Wifi modem or router for an additional ethernet cable?YesNoI do not have a routerWhat is the distance between the preferred location for your EV charger and your switchboard?I’m not sureLess than 10mBetween 10-20mBetween 20-30mGreater than 30mDo you have space available in your switchboard?YesNoI'm not sureDo you have easy access to your switchboard?YesNoI'm not sureOccupancy TypeCommercial owner / occupierCommercial rentalResidential owner / occupierResidential rentingLandlord ApprovalYesNoN/APhoto UploadPlease take a clear photo of each of the following locations and upload for us to be able to accurately provide you with a quote. Preferred location of chargerPlease take a clear photo of the exact location where you would prefer your charger to be installed. Switchboard locationPlease take a clear photo showing the outside of your switchboard in the centre of the photo with at least 1m of the surrounding area showing on each sideInside your SwitchboardPlease open your switchboard and take a clear photo of the complete board showing all components inside. Install AvailabilityI would prefer a site visit and quote before proceeding. Yes, additional charge applies. No Standard installation is Monday- Friday between 7am and 3pm. Do you require installation outside of these hours for an additional fee?No – I am available at the standard timesYes – after 3pm Monday-FridayYes, on SaturdayYes, on SundayDo you have any special access or other requirements on installation day? Yes No Please describe your special access or other requirements on installation day?Do you have any additional electrical works that you would like us to quote and complete for you while we are on site? Yes No Additional electrical works detailsAdditional comments or notesSomeone from Chargers Direct will contact you shortly to book a phone consultation to assess if a site visit is necessary.Depending on your internet connection and the images you added to the form, it may take a while for this form to submit. Please keep this tab open until you see the thank you page.