Customer Sign Off

Please also be sure to email a copy of your project quote and any additional project costs (electrician's quote, ev charger receipt if purchased separately) to ev@unitil.com.

Name

Phone Number

Email

Service Address

Town

Do you own the property where the charger is being installed?

Yes

No

If you do not own the property where the ev charger is will be installed, please email a copy of your lease and written approval from their landlord briefly describing the project to ev@unitil.com after submitting this questionnaire. See section 3. of the Terms and Conditions.

Have you applied for or do you plan to apply for other ev charger incentives in addition to the Ready2Charge Rebate Program?

Yes

No

Read the Terms and Conditions.

The submittal of an Application does not guarantee a rebate will be issued. The eligibility of the Customer’s Application and the amount of the Rebate is at the sole discretion of Unitil.

I have read and reviewed for accuracy the EV Charger Installation Questionnaire submitted on my behalf

I understand I will be automatically enrolled in the EV Time-of-Use rate

Signature

Signature Date

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