Smartmotion Warranty Claim Form

Claim Date *

Retailer Name

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Email *

Contact Person

Phone *

Name *

First

Last

Purchase Date *

Bicycle Model *

Frame / Serial *

Battery Number *

Battery Voltage *

Service Date

Speedometer *

Is this a controller fault? *

Controller Type

Controller Serial Number *

Fault; Diagnosis *

Parts Affected *

Comment

File Upload 01

Click or drag a file to this area to upload.

Upload or attach a photo or document for the warranty claim ie photo of frame number, purchase doc

File Upload 02

Click or drag a file to this area to upload.

Upload or attach a photo or document for the warranty claim ie photo of frame number, purchase doc

File Upload 03

Click or drag a file to this area to upload.

Upload or attach a photo or document for the warranty claim ie photo of frame number, purchase doc

Name