Ready Charge Pilot Program Enrollment

Required Documentation

To enroll in the Ready Charge Program, applicants must provide the following with this application:

Proof of ownership or lease of the Site, such as a deed of title or copy of lease

If leasing the Site, copy of the property owner’s written consent to the installation of an EV charging station(s) at the Site

Email completed application and required documents to: electric.vehicles@libertyutilities.com

Liberty Ready Charge Pilot Program Enrollment Application

CUSTOMER INFORMATION

Customer name on electric account

Liberty Account Number (from utility bill)

Location where electric vehicle (EV) charging station or stations is to be installed (“Site”)

Street Address

City

State

Zip

Contact Name

Phone Number

Email address

Description of proposed charger location (relative to buildings, areas, or parts of the property)

Are you signed up for e-bill/paperless billing?

Yes

Do you currently have EV charging stations at the Site? Yes or No

Are there any corporate and/or local environmental initiatives within any part of your organization’s operations? Yes or No

CHARGING STATION PLACEMENT

Are you located along a major travel corridor?

Are you a minority owned business?

Is the location proposed publicly owned (i.e., park, school, city)?

What amenities are located nearby? List all

What security is in place at your location?

CHARGING STATION TYPE

Participants in the Ready Charge program may not install more than three dual-port L2 chargers or three DCFC chargers, or a combination of the two types of chargers, up to three total, per participant location.

Please indicate the number of chargers for each type you are interested in hosting at the Site:

DCFC

Agreement

I accept the terms and conditions*

Print Name of Applicant

Date

SURVEY

I am interested in participating in the Ready Charge Pilot Program because (check all that apply)

Liberty Ready Charge Pilot Program allows me to host the stations without the initial investment and operational responsibility

I want to support the environmental benefits of driving an EV

Helps support corporate sustainability goals

Benefits to my business

Supports the overall EV growth in my community

My customers are asking for this service

Other (specify)

*Acknowledgments

Applicant acknowledges that its participation in the program is contingent upon the execution of the Participation Agreement and payment of Program Enrollment Fee.

Applicant will permit Liberty representatives to inspect the site of intended installation on a mutually satisfactory date and time.