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Address details
Name
*
E-mail
*
Name HOA
*
Parking space(s)
*
Role
*
Co-owner
Tenant
Telephone number
Street
*
Billing address
House number / flat number
*
Billing address
Postcode
*
Billing address
Town/city
*
Billing address
Driving information
I currently drive a
*
Petrol car
Electric car
Hybrid car
I expect to keep using it for *
< 4 years
4 to 8 years
> 8 years
My next car will probably be a
Petrol car
Electric car
Hybrid car
I don' know yet
My annual mileage is
*
<10000 km (<200 km/week)
>10000 km (>200 km/week)
>15000 km (>300 km/week)
>20000 km (>400 km/week)
>30000 km (>600 km/week)
>50000 km (>1000 km/week)
My total daily distance on 90% of the days is
*
<50 km
<75 km
<100 km
<150 km
>150 km
Usual parking times
At night on weekdays
During the day on weekdays
At night at weekends
During the day at weekends
I have no regular pattern
Charging information
Do you alreay have a charging point
*
Yes
No
I would like a charging point within
*
<6 months
<4 years
>4 years
Vehicle ownership
*
Company car
Private car
Both
Employer's reimbursement method
*
Employer's charging card
CREG Tariff
Reimbursement of documented costs
Unknown / other
Other comments
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