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Efficiency Maine is seeking Qualified Partners with experience (Efficiency Maine)

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LEVEL 2 ELECTRIC VEHICLE CHARGER
QUALIFIED PARTNER APPLICATION
168 Capitol Street, Suite 1, Augusta, ME 04330 | (866) 376-2463 | efficiencymaine.com
1 Rev 4.23.19
Efficiency Maine is seeking Qualified Partners with experience installing Level 2 (240v) electric vehicle chargers to be listed on our
website as a resource available to customers participating in “Phase II” of our electric vehicle supply equipment (EVSE) program.
INSTRUCTIONS: Using the highlighted fillable fields, please fill out the form electronically and email to
jack.riordan@efficiencymaine.com. Leave fields blank if you are unable to answer the question or if the question is not relevant to
you.
For general information about electric vehicles and charging visit efficiencymaine.com. For more information about the
commercial electric vehicle (EV) charger grant, call Efficiency Maine at (866) 376-2463.
Applicant Information
Business Name
Please indicate if you are an equipment supplier or installer (check all
that apply):
❏Supplier ❏Installer
Primary Contact Person
Mailing Address
State
Zip
Applicant Phone Number
Applicant Website
Please estimate the total number of level 2 electric vehicle
chargers you have installed or sold. If possible, list the brand:
Please indicate what portion of Maine you serve (check all that
apply):
❏Entire State ❏Androscoggin ❏Aroostook ❏Cumberland
❏Franklin ❏Hancock ❏Kennebec ❏Knox ❏Lincoln ❏Oxford
❏Penobscot ❏Piscataquis ❏Sagadahoc ❏Somerset ❏Waldo
❏Washington ❏York
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Efficiency Maine is seeking Qualified Partners with experience (Efficiency Maine)

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Completed 23 July 2021

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