Alfa Romeo Dealership Form

Step 1

I have advised the customer that they require the following to proceed with having an electric vehicle charge point installed at their home.

Be the homeowner or have the permission of the homeowner.
Have a private off street parking space on the property.
Have strong working Wi-Fi.

Advice was given to the customer?

Yes No

Step 2

Is the customer currently on supply with Energia?

Yes No

Please provide the customers MPRN number, (the MPRN can be found at the top of an electricity bill)

What is the customers house type?

Customer’s full name (as it appears on electricity bill)

What is the customer’s full address?

What is the customer’s Eircode?

What is the customer’s mobile number?

What is the customer’s email address?

What is the sales agent full name?

Fiat dealership name

Fiat dealership email

What are the last 6 digits of the VIN number?

I (the customer) confirm that I consent to the information within this form being passed to Energia Group and the named dealership, its parent company and subsidiaries, for the purposes of this Agreement:

I (the customer) confirm that I have received the Point of Sales material from the dealership which provides full details and Terms and Conditions of this offer and Energia privacy statement.

By submitting this form you consent to Energia contacting you in relation to this enquiry. For details on how we use your information, please view our Privacy Statement.

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Alfa Romeo Dealership form