17 - RocketEV Home Installation Appointment Request Form

EV Home Installation Request

Seamless EV Installation Booking - It is important that we receive as much detailed information as possible to ensure we can quote your project accurately. Providing photos of your electrical panel, garage layout or other relevant images will be helpful for our review. **Please be advised that due to high demand we may not be able to accommodate your requested booking day and time. One of our appointment coordinators will be in touch with you to confirm the site consultation.**
Full Name*

First NameLast Name
Phone*

Area CodePhone Number
E-mail*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
What is your preferred method of contact?*

Phone callText MessageEmail
What is your preferred timeline for an initial site consultation? Please be advised that due to high demand we cannot guarantee your selected time-slot. A representative will be back in touch to confirm.*

This WeekNext WeekOther
What type of home do you live in?*

DetachedSemi-DetachedTownhomeCondo
Is there an electrical outlet in your garage?*

YesNoUnknown
What voltage is the electrical outlet in your garage?*

120v (Toaster)240v (Dryer)Unknown
Where is the electrical panel located in the home?*

BasementGarageUnknownOther
Approximately how far in feet is the electrical panel located from the garage? – Distance in ft.*

25'50'UnknownOther
When do you expect to receive the vehicle?*

1 month3 months6 months1 yearAlready in possession.
Are there any specific instructions that our install team should be aware of?
Please list the Dealership where purchased if applicable.*
Please list the Dealership Sales Consultant if applicable.
Please list the vehicle type purchased if applicable.
Ex: Audi Etron / Tesla 3
Upload Supporting Images

Add Photo
EX: Electrical Panel in House & Electrical Outlet in Garage Cancelof
Should be Empty:

EV Home Installation Request