Fillable SERVICE PROVIDER APPLICATION (Efficiency Maine)

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SERVICE PROVIDER APPLICATION (Efficiency Maine)

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ELECTRIC VEHICLE CHARGER
SERVICE PROVIDER APPLICATION
168 Capitol Street, Suite 1, Augusta, ME 04330 | (866) 376-2463 | efficiencymaine.com
1 Rev 4/6/21
Efficiency Maine is seeking information from vendors and service providers that manufacture or provide ancillary services associated
with the procurement and installation of Electric Vehicle Supply Equipment (EVSE) or “EV chargers”. These services could include,
but are not limited to, the manufacture of EVSE hardware, EVSE networking software, project management, engineering, electrical
installation, and other potential services related to EVSE installation. These companies will be listed on our website as a resource for
customers applying for funds through Efficiency Maine’s EV charging initiatives. Separate lists of Installers, Suppliers, and Service
Providers offering Project Management assistance are posted here:
https://www.efficiencymaine.com/evehicles/electric-vehicle-
resources/.
INSTRUCTIONS: Please complete the form electronically and email as an attachment to ev@efficiencymaine.com
with the subject
line “EV Service Provider Application”. Please mark “N/A” in the fields that are not relevant to you.
For general information about electric vehicles and charging visit efficiencymaine.com/ev. For more information about the
commercial electric vehicle (EV) charger grant program, call Efficiency Maine at (866) 376-2463.
Applicant Information
Business Name
Primary Contact Person
Mailing Address
Mailing City
Mailing State
Mailing Zip
Applicant Email Address
Applicant Phone Number
Applicant Website
Please indicate what services your company currently offers associated with electric vehicle charger procurement and installation (check
all that apply):
❏EVSE hardware: ❏ Level 2 chargers ❏ Level 3 chargers ❏EVSE networking software services and point of sale capabilities
❏Project Management (examples: selecting and securing “host sites”, evaluating electrical/power needs, hiring and overseeing
electrician, etc.)
❏Engineering (examples: preparing site plans and any necessary site work plans, providing traffic data, evaluating electrical/power needs,
etc.)
❏Electrical Installation (examples: installing EV chargers, securing necessary permits, etc.)
❏Additional site work (examples: wayfinding and EV signage, curbing, striping and/or marking of parking spaces, etc.)
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SERVICE PROVIDER APPLICATION (Efficiency Maine)

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Completed 23 July 2021

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