New Project Questionnaire

JIREH PROJECT INTAKE FORM

Desired Project Commencement Date *

Fulfillment Type *

Order Placement

Request for Quote

Request for Consultation

Lead Type *

HOT

WARM

COLD CALL

Sales Representative Information

Rep First Name *

Rep Last Name *

Rep ID *

Phone number *

Email Address *

Client Information

Business or Company *

Address *

Address 2

City *

State *

Zip or Postal Code

Shipping-Phone *

Shipping-Contact *

Client Email Address *

Property | Project Information

Property Type *

Dedicated EV Charging Station Depot

Multi-Family Residential | Apartment Complex

Mixed Used | Retail Development

Commercial Development | Workplace Charging

Hotel | Movie Theater | Shopping Mall | Plaza

Parking Lot | Parking Garage

Public or Private Use?

PUBLIC

PRIVATE

AC Level 2 Chargers

AC Chargers

EV Swift Home Charger – 9.6 kW

EV Swift 1000 – 7.7 kW

EV Swift 1003 – 7.2 kW

EV Swift 1007 – 19 kW

Integrated Solar Canopy

DC Level 3 Fast Chargers

DC Fast Chargers

EV Ascent Max 5000 – 120 kW

EV Ascent Max 5003 – 150 kW

EV Ascent Max 5005 – 180 kW

EV Ascent Max 5007 – 240 kW

EV Ascent Max+ NE – 360 kW

Integrated Solar Canopy

EV Tech Project Financing (minimum project value $100K) *

YES

NO

Property Value

Annual Operating Income

Client is Property Owner? *

YES

NO

Other Comments | Info

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