Residential Smart Charge Program

Required Documentation

To enroll in the Residential Smart Charge Pilot Program, applications must provide the following with application:

Documentation of legal possession of an EV via ownership, lease, or other suitable arrangement (as determined by Company)
Documentation that you own or lease the residence where the EV charger will be installed and, if leasing, have the property owner’s written consent for the scope and nature of the modifications to the premise
Confirmation that the scope and nature of modifications to the occupied premises typically required for the operation of a Company-Approved Charging Device have been communicated and consented to by the property’s mortgage holding institution(s) and all insurance provider(s)

NOTE: Should the vehicle, property, or Liberty account holder names be different across the documents, applicants must provide proof of residency and sharing of living premises by the individuals whose names appear on these documents.

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

Liberty Residential Smart Charge Program Enrollment Application

CUSTOMER INFORMATION

Customer name on electric account

Liberty Account Number (from utility bill)

Location where charging equipment is to be installed:

Street Address

City

State

Zip

Contact Name

Phone Number

Email address

Do you own this property? Yes or No*

How did you hear about this program?

Are you applying as an Income-Qualified Participant (currently enrolled in the Low-Income Pilot Program)? Yes or No

Are you signed up for paperless billing? Yes or No

INSTALLATION

Is the home within the city limits? Yes or No

Where will the charger be installed?

Attached garage

Detached garage

Not in a garage*

Which best describes the types of wall construction where the EV charger will be located?

Finished (dry wall installed)

Unfinished (no drywall installed)

Both finished and unfinished

VEHICLE INFORMATION

Vehicle Type

Battery Electric Vehicle (Total electric vehicle with no other source of fuel)

Plug-in Hybrid Electric Vehicle (Vehicle plugs in but has another source of fuel)

Vehicle Make

Vehicle Model

Date purchased/leased/received for use

Agreement

I accept the terms and conditions*

Print Name of Applicant

Date

SURVEY

Demographic Information (providing this information is voluntary and not required to approve the application)

Primary driver age

Gender

Number in household

What major barrier did you have to overcome to purchase an EV? (check all that apply)

Make/Model Availability

Availability of public charging stations

Initial purchase price

I purchased/leased an electric vehicle because (check all that apply)

Liberty Smart Charge Subscription Program

Environmental benefits of driving an EV

Available rebates/tax incentives

Total cost of ownership

Vehicle brand

Vehicle features

Other (specify)

Approx. how much do you currently spend on fuel per month?

How many miles you expect to drive this vehicle per month?

*Acknowledgments

Applicant acknowledges that their participation in the program is contingent upon the execution of the Participation Agreement and payment due upon execution and meeting program requirements to Liberty’s satisfaction.

Applicant will permit Liberty representatives to inspect their premises to review installation requirements on a mutually satisfactory date and time.

Applicant understands that by participating in the program, their consumption will be billed under a new tariff rate schedule that will, among other things, establish separate rates and charges for the electricity consumed through the Liberty-Approved Charging Device, the cost of the charger itself, and for general household consumption.

Applicant acknowledges that they will need to permanently transfer to an electronic billing arrangement for their household as a condition of participating in the program.