United EV Enrollment Form

Member Information

Account Number

First Name

Must match name on account.

Last Name

Must match name on account.

Service Address

City

State

Zip Code

Phone

Application ID

Enrollment Information

Preferred Date of Charger Installation

Please select a date between Monday - Friday. Weekend service unavailable.

Select Time of Day

Where Will EV Charger Be Located?

EV Make

EV Model

Select Residential Rate Option

United Power recommends the Time of Day rate.

Select Charging Schedule

United Power recommends Simple Saver.

Upload Photo of Installed NEMA 14-50 Outlet

United EV Program Agreement

Enrollment in the United EV Charging-as-a-Service Program is contingent upon signing the program agreement. Please review and sign the program agreement.

Please agree to the following statements before submitting your enrollment form.

I have read and agreed to the United EV program agreement.

I have a NEMA 14-50 outlet installed by a certified electrician at this location. The charger pigtail is 12 inches so the charger will be placed adjacent to the outlet. (Click here to apply for our Make Ready Wiring Rebate.)

I acknowledge that the charger will be connected to my home Wi-Fi service and that a signal is available at the location where the charger will be installed.

I have the consent of the property owner to enroll in the United EV at this location.

Please tell us where you purchased your EV.