Electric Drive
smart Electric Drive

smart is inviting applications for up to 100 users to participate in ‘electric drive'’ research trials across the London South East and West Midlands regions, beginning 2010. The research will be conducted using second generation smart ed’s with new lithium-ion battery technology for a minimum of 12 months and leases will be subsidised by public funds. The trials are a unique opportunity for users to influence the product development and design process, and will include a focus on domestic recharging behaviours. Applications for the 2010 trial opened in June and we have recently closed the first phase. In completing this application form you will be placed in the reserve list and will be contacted in due couse.

Please complete and return the following form to apply for this programme.
I am a (mark as appropriate)... *
Private customer Business customer Could be either private or business customer

Personal Details

Title *

First Name *

Surname *
 

Postcode *

Choose *

 

Town *

County *
 
How long have you lived at your present address (years)? *
 
If less than 2 years, please provide previous address:
 

Telephone (Home)

Telephone (Business)
 

Mobile

Email

Socio-economic

Gender (mark as appropriate) *

 Male Female
 

Age group (mark as appropriate) *
Under 20 yrs 20 - 24 yrs 25 - 29 yrs 30 - 34 yrs
35 - 39 yrs 40 - 44 yrs 45 - 49 yrs 50 - 54 yrs
55 - 59 yrs 60 - 64 yrs 65 - 69 yrs 70 yrs or more
 

Gross Annual Income (mark as appropriate) *
Less than £20k £20k-£29k £30-£39k
£40k-£49k £50k-£74k £75k or more
 

Property Type (mark as appropriate) *
Apartment / Flat Terraced House Bungalow  
Semi-Detached House Detached House Other (please specify)
 
Are you a home owner? Yes No
 

Employment Status (mark as appropriate) *
Employed Unemployed Self-employed Other (please specify)
 

Professional

Job Title *
 

Name of Employer *
 

Employer Address *
 

Your primary place of work if different from employer address above
 

Nature of employer’s business *

Infrastructure
Parking (mark as appropriate)
 
Do you have access to off-street parking at home? * Yes No
 
Do you have access to off-street parking at work? * Yes No
 
Recharging (mark as appropriate)
 
Do you have access to external or garage mains power at home? * Yes No
 
Do you have access to external or garage mains power at work? * Yes No
 
Who is your current domestic electricity tariff provider? *
 
Would you be prepared to switch tariff provider (if required) to participate in this trial? * Yes No
 
Would you be prepared for your tariff provider to install a smart meter at your home? * Yes No
 

Vehicle Usage

How many vehicles do you presently own? *
 

What is the make / model / age of your primary vehicle? *

 Age Yrs
 

Would the smart ‘ed’ replace or supplement any of these vehicles? *
Yes No
 

How often do you use a car to drive……..(mark as appropriate) *
  everyday more than once per week once per week occasionally never
...in the city
...on country roads
...on main roads
...on motorways
 

How often do you use a car for……..(mark as appropriate) *
  everyday more than once per week once per week occasionally never
...trips less than 5 miles
...trips of 5 to 20 miles
...trips of more than 20 miles
...private trips (shopping etc)
...commuting to work
 

Please estimate your typical average daily mileage (mark as appropriate) *
less than 5 miles 5 – 19 miles 20 – 29 miles 30 – 39 miles
40 – 49 miles 50 – 59 miles 60 – 69 miles 70 miles or more
 

Have you ever used or owned an electric vehicle before? *
Yes No
   
If yes, please provide details of vehicle type and period  of use / ownership:

 

  

If yes, what was your overall impression of the experience?
 

Would you be prepared to rent or lease a smart ‘ed’ over a 12 month period (indicative costs are sub-£250 per month) *
Yes No
 

Would you be prepared to be the subject of a credit history check? *
Yes No
 

Would you be prepared to sign a Non-Disclosure Agreement (NDA)? *
Yes No
 

Would you be prepared to lease or rent a vehicle equipped with data-loggers which remotely monitors your usage patterns? *
Yes No
 

Would you be prepared to participate in the following research activities over the course of 12 months? (mark as appropriate)
 

Face to face interviews *
Yes No
 

Customer focus groups *
Yes No
 

On-line questionnaires *
Yes No
 
Please explain your motivations for wishing to participate in this trial. *

Fair Obtaining Statement

We smart, a trading name of Mercedes-Benz UK Limited, or other Daimler Companies or, our dealership network, or our agents, may use your personal details and information we obtain from other sources to contact you about our products, services and special offers, or customer services, or for the purposes of research and analysis.


By providing us with your mobile telephone number or email address you consent to being contacted by these methods (which may include SMS) for these purposes.  We will not share your data with any third parties.

 

If you do not wish to receive information in a particular format please tick the relevant box Not by:

Post

Tel

Email

SMS

 

If you change your mind about your marketing preferences or wish us to rectify any of your personal data please let us know by contacting the Data Department, Mercedes-Benz UK Limited, Tongwell, Milton Keynes, MK15 8BA
Would you like us to remember your data for the next time?