Contact Information

Name*

First Last

Phone Number*

Email Address*

Address*

Street Address Address Line 2 City State ZIP Code

Business Entities*

How Long Have You Been in the Fueling Industry?*

Property Information

Address*

Street Address Address Line 2 City State ZIP Code

Own/Lease*

Own
Lease

Size of Entire Lot*

Is Your Fuel Currently Branded?*

Yes
No

Do you have a Current Supply Partner?*

Yes
No

Who is Your Current Supplier?*

Contract Expiration Date*

Do You Have Other Alternate Profit Centers?*

Yes
No

Other Profit Centers?*

Does Your Property Have a Car Wash?*

Yes
No

Monthly Washes*

Does Your Property Have a C-Store?*

Yes
No

Is it Branded?*

Yes
No

Monthly Sales*

Does Your Property Have Diesel?*

Yes
No

Number of Dispensers*

Pre-Qualify Questions

Do You Have Natural Gas at Your Location?*

Yes
No

Do You Have Electric 480 VAC, 1010 A, 3-Phase Onsite?*

Yes
No

Do You Have Water at 0.5" Compression at 8gpm (psg) Capabilities?*

Yes
No

Is Your Location in the City Limits?*

Yes
No

Do You Have Adquate Ingress/Egress for Vehicles?*

Yes
No

Answering no to any of these questions will not immediately disqualify a station, but will give PowerTap and Andretti an idea of any additional accommodations that may need to be resolved prior to installation.

Generate Hydrogen On-Site with PowerTap® Hydrogen

Pre-Qualification for Hydrogen Fueling Installation

Contact Information

Property Information

Pre-Qualify Questions