1. Van model and year
2. Desired electricity consumption (select a box)
Autonomous (100% Solar)Energy from Home Grid (Shore Power)Mixed
3. Implementation (select multiple boxes)
BathroomInternal showerExternal showerHot waterFridgeWorktopChemical ToiletDouble bedAccessory bedOverhead furnitureStore
4. Periods of use (select only one box)
0-3 days3-7 days7-14 days15 days or more
5. Overnight area (you can select only one box)
With access to electricity/waterNo access to electricity/waterMixed
6. Additional observations
7. Name
8. Mail
9. Telephone / mobile (Example +569 12345678)