EmailMe Form - Warranty Application form

Shop Name *

Contact name *

Account Number

** Staff use only

Address *

Street Address City State / Province / Region Postal / Zip Code

** Need not fill this out if you are an account customer

Email *

Phone *

Date of purchase *

DD / MM / YY

If brand new and unsold, put todays date

Item Code

Bicycle Brand *

Model *

Year

Serial Numbers *

Please Write all serial numbers visible

Failed part *

Size *

Failure / Fault description *

Proof of purchase *

This is a required field if the bicycle has been sold to the customer, but not for bikes that are damaged upon arrival when brand new and unsold.

Claims for bikes that have been sold to a customer, without proof of purchase submitted on this form will be immedietly denied.

Photo of Serial Number *

Photo of Damage *

Photo of Bike

Extra photo if needed

Sales Rep

James Huang

Jason Eve

Matt James

Heinrich Stroebel

Craig Brown

Nathan Bradbery

If you want your sales rep CC'd into this warranty process, check the name of your sales rep. This is not required.