EVSE Repair/Upgrade/Recycle Service - Questionnaire from EVDoctor 4Earth
Thank you for your purchase of the EVSE Repair, Upgrade or Recycle Service and submission of your EVSE specific information. Please review the information below and edit as needed. Please bookmark this page so that you can return to this form in the future to add additional information. EVDoctor - We are here to help you.
Vehicle Make, Model & Year
Where Did You Purchase this Service
EVSE Charger Make, Model & # Amps (ie 16A)
EVSE AC Power Connection
Hard Wired, no plug, 240VAC
NEMA 5-15P - 120V
NEMA 6-20P - 240V
Nema 6-30P - 240V 30A (3 pin)
NEMA 10-30P - 240V Dryer (3 pin)
NEMA 14-30P - 240V Dryer (4 pin)
NEMA 14-50P - 240V Range/RV Park
EVSE Failure Symptom
Additional Notes - Pls include the size & weight
Return Full Name, Shipping Address & Phone #
Release of Liability
The Buyer assumes all liability including consequential damages for the use of the repaired items. By the submission of an EVSE for repair, the Buyer absolves EVDoctor 4Earth for all liability resulting from the use of the EVSE repaired by EVDoctor 4Earth.
Signature - I absolve EV Doctor 4Earth of all liability associated with the use of this repaired EVSE - type your full name
In House Information - Do not fill in
Repair ID # (in house use only)
Diagnosis (in house use only)
A copy of your responses will be emailed to the address you provided.
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