Revolt Program Enrollment

First

Last

Service Address

City/Town

ZIP/Postal Code

Phone

SWCE Account Number

Electric Vehicle Information

Make

Model

Year

VIN Number

License Plate #

Purchase Date

Maximum Electric Range (miles per charge)

When do you primarily plan to charge your BEV or PHEV? (Check all that apply):

Overnight (off-peak)

Morning

Afternoon

Whenever my car needs a charge

Are you aware of SWCE's EV specific rate options and level 2 charger rebates?

Yes

Please contact me with more information about this program.

Date

Signature

By signing this application, I certify the electric vehicle I am enrolling in the Revolt program is installed at the address listed above, and that I am a SWCE member.

In the event of an emergency: Please do not use email to contact SWCE. We cannot guarantee messages received via email will be monitored during an outage.