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Car brand

Car model

Select the number of metres from the charging station to the meter cupboard

Do you want the charging station mounted on the wall or on a pole?

On the wall

On a pole

Is the charging station for business or private use?

Business

Private

Personal information

Title*

Mrs.

Mr.

First name*

Last name*

Email*

Phone number*

City*

Data processing*

Yes, I give permission to use my personal data in accordance with the 50five privacy policy.