Repair Form
About You
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mobile
*
Email
*
example@example.com
Appointment request
*
About Your eScooter
Scooter Brand
*
Dualtron
EGlide
Kaabo
Mercane
Segway
Unagi
Xiaomi
Zoom
Zero
Other
If other, what brand?
Scooter Model?
e.g Segway is the brand, Ninebot is the model
Date Purchased
*
-
Day
-
Month
Year
Date
If purchased from iScoot, what was your invoice number?
Serial Number
Km's Done?
*
Detailed description of issue relating to your cliam:
Please provide some images
Browse Files
Cancel
of
Have you set up a password to lock your scooter via an app?
Yes
No
Please provide a TEMPORARY password for us to unlock in order to complete repairs
I understand that the password MUST be a TEMPORARY PASSWORD and agree to change the password once the scooter is returned,
*
I agree
I understand that my chosen time needs to be confirmed by iScoot
*
I agree
Signature
Clear
Submit
Should be Empty: