Nissan Intake Form

Home Charger Installation for Nissan Vehicles

Provided by RocketEV Charging Solutions
RocketEV is proud to be Nissan Canada's EV Home Charger Installation partner.

The process for electrifying your home with RocketEV is simple:
1. Request a FREE consultation by submitting this form
2. A RocketEV agent will aim to contact you within 2 business days to book a consultation.
3. A licensed electrician will conduct the consultation and provide a quote
4. Based on your approval of the quote, an installation will be booked when it is mutually convenient.

Home EV Charger Installation Form
Full Name*

First NameLast Name
Phone*

Area CodePhone Number
E-mail Address*
Address*

Street Address

Street Address Line 2

CityProvince

Postal 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.*

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 your vehicle?*

Already in possession.0-2 weeks1 month3 months6 months1 year
Are there any specific instructions that our install team should be aware of?
Please list the Dealership where purchased.*
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
Helpful photos would be: panel, charger location, wire path from panel to charger, etc. Cancelof
Should be Empty:

Home Charger Installation for Nissan Vehicles