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BlazingStar Energy_Client Questionnaire
A BlazingStar Energy Client Questionnaire to determine your electrical details.
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* Indicates required question
Email
*
Your email
Date
*
MM
/
DD
/
YYYY
Your name please
*
Your answer
Your address for service please
*
Your answer
Your Electric Utility Company
Xcel
Dakota Electric
MVEC
Shakopee PU
Connexus
Rochester PU
Benco
Other:
Your Electric Utility Company Account Number
Your answer
Are you interested in a program offered by your Electric Utility Company for reduced electric rates?
Yes
No
Electric Utility Company Reduced Rate Plan Name
Leave blank if Unknown
Your answer
Your Main Circuit Breaker Amperage
Your answer
Your Electric Vehicle model
Your answer
Your EVSE Connection Preference
Hardwired EV Charger
14-50 Receptacle (additional costs due to GFCI & Neutral requirements)
EV Charger provided by
I will provide my own EV Charger
BlazingStar Energy LLC ($ cost TBD)
Other:
Appliances
N/A
Gas
Electric
Furnace
Hot Water Heater
Stove / Range
Oven
Laundry Dryer
Air Conditioning
Dishwasher
Garbage Disposal
N/A
Gas
Electric
Furnace
Hot Water Heater
Stove / Range
Oven
Laundry Dryer
Air Conditioning
Dishwasher
Garbage Disposal
Clear selection
Approximate distance of Circuit Breaker Panel to desired EV Charger installed location
Your answer
EV charger available WiFi Network Name (SSID) & Password (used for EV charger permanent internet connection)
Your answer
Notes & Additional Details of your project:
Your answer
How satisfied are you with this Questionnaire?
Very annoying
1
2
3
4
5
Very easy
Clear selection
Any improvements on this questionnaire you'd like to see?
Your answer
Send me a copy of my responses.
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