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Request A Charger
Micro Real Estate
Request A Charger
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Name
*
First
Last
Email
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Type of Business or Activity That You Represent
*
Retail Store
Restaurant
Hotel/Motel
Apartment Complex
Hospital
Office Building
Parking Garage
Marina
Other Recreational Activity (trails, parks, sports fields/complex, etc)
Farmer's Market
Library
Other (Please Explain in Comments Section)
Does the business you represent own the parcel of land where you would like the charger to be installed?
*
Yes
No
Estimated Charger Usage Time Per Day
*
Under 1 hour
1 to 8 hours
8 to 16 hours
16 to 24 hours
Estimated Weekly Number of Visitors to The Business You Represent
*
Under 10
10 to 99
100 to 999
1000 to 9,999
Over 10,000
Comment or Message
*
Submit