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Fully Charged Applicants Form
Please​ ​fill​ ​out​ ​this​ ​form​ ​to​ ​the​ ​best​ ​of​ ​your​ ​knowledge,​ ​(Or print,​ ​scan​ ​and​ ​e-mail​ ​it​ ​to​ ​
By filling out this form, you have permission or are the business owner or other relevant person from the business.
Under no circumstance will any of the information you provide here in this form be sold or used by anyone other than
those involved with the Fully Charged scheme. If you have more than one business, feel free to fill out this form more than
once but change the "Name of business applying" entry appropriately. You must complete this form before 31st August
2017. Deadline extended to 10th Nov 2017.

If you need help, please e-mail Cyrene Powell at or phone on 077380 93696. Thank you
for your time, and best of luck.

Email address *
Full name of who will be the main contact *
Your answer
Main contact's phone number(s) *
Your answer
Full name of business applying *
Your answer
Postcode of business *
Your answer
What electoral ward is the business in? *
Approximately how many visitors/guests do you have every week? *
How long do visitors/guests typically stay at your business/venue? *
How many car parking spaces are there? *
Is there a suitable wall adjacent to your business with a parking space? *
Do any EVs routinely visit your establishment? *
Do any staff members have an EV? *
Are you thinking of purchasing an EV for your business? *
Do you provide refreshments? *
Does your business have/use social media? *
If your business has a website address, please enter it below
Your answer
How did you hear about the grant scheme? *
Any comments?
Your answer
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