Registration Form Repair/Maintenance (NL)

Registration Form Repair/Maintenance

Let us know how we can help you!
Name*

First nameSecond name
Phone number*
Enter a valid phone number.
E-mail address*
example@example.com
Address details*

Street name + house number

Street Address Line 2

CityState / Province

Postal codeCountry
Repair details*
Complaint description*
This form will be read by the mechanic. Please explain the complaint in as much detail as possible.
If your bike stopped working or does not turn on: does your display turn on?*

YesNo
Are you handing in the bike?*

YesNo
Are you handing in the battery?*

YesNo
Are you handing in the battery key?*

YesNo
Are you handing in the charger?*

YesNo
Is the bike insured?*

YesNo
If the bike is insured through ANWB, please include the policy number here.
Would you like to have a maintenance service performed?*

YesNo
Would you like to be informed about the (additional) cost of your repair or maintenance?*

No, I don't need to be informed.Yes, if costs exceed €100,-.Yes, if costs exceed €150,-.
The examination fee is €49.95 for an unrepaired return. Quotes for repairs or servicing under €100 (excluding standard servicing charges) are automatic. If you require a quote first, the repair time may be longer and the cost will increase due to additional labor hours.
Important instructions:
- If you are turning in two bikes for repair/maintenance, please complete this form for each bike separately.
- If you have a service card, please bring it with you when you turn in your bike. Without the service card, you will unfortunately not be able to use the corresponding service benefits.
- When returning the battery, please always bring the corresponding key(s). This also applies when you return the bike including the battery.
- If your bicycle is older than two years, we will charge a transportation fee. The cost per single ride is as follows:
  - Regular (electric) bicycle: €37,50
  - (Electric) cargo bike: €75,-
Should be Empty:

Registration Form Repair/Maintenance

Important instructions: