Customer Repair Request Form FULL NAME * DATE * ADDRESS * CITY * ZIP * PHONE * EMAIL (the diagnostics report will be sent here) * Ebike/escooter make and model: o Ebike / escooter; o Battery; o Battery charger; o Additional parts (describe): Issues and services: By my submitting below, I confirm that I am the bike/scooter owner and authorize the company to take any necessary action for repairs. I will not have any complaints against the company if they refuse to serve me or cannot fix my bike for any reason. Δ
