Project Design Questionnaire

Please fill in as much information as you possibly can in the form below to help us scope the design to meet your needs. If you have any questions about the information requested, send us a note at info@harveyev.com.

* = Required Fields

	Design
*Design Name:
	Your Contact Information
*Your Name:
Company:
Street Address:
*City:	State/Province: Zip Code
*Country:
*Email:
*Day Telephone:
Evening Telephone:
Fax:
	Donor Car Vehicle Information
*Vehicle Type:
Model Information:	Year: Make: *Model:
*Transmission:	Manual Automatic No transmission in Vehicle
*Own Donor:	Yes No
Other Information:	Tell us anything else you think we need to know about your vehicle
	Performance Requirements
*Range:	miles between charges
*Top Speed:	mph
*Total Passenger & Cargo Weight:	lbs.
*Number of Passengers:	including driver
Additional Optional Features You Want:	Air Conditioning Power Steering Power Brakes (reccommended)
*Typical Cargo You Carry:	None Odd n Ends Groceries Bulk
*Typical Driving Conditions:	Local/In Town Hiway Semi to Steep Hills
*Your Planned Charging Location:	Garage Covered/Carport Outside At Destination
	Equipment Info
	Do you already own any components (motor, controller, charger, batteries) you wish to use in this conversion? If so describe below: