New Rider Rental Application

Log in
Your Name*
Age (Min 21yrs)*
Mobile Number*
Email*
Your Registered Adrress:*

State / Province
You may prove your address by downloading a scan .pdf or upload a photo of your utility bill. For example: a phone, or utility document clearly showing your address. (documents must have been issued within the last two months)
Photo of your Proof of Address*:
or Upload .pdf as proff of address (phone bill, utility bill, etc)

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About your E-Moped rental
When would you like your Rental to start? (Pick-Up)*

DayMonthYear
Date
Select the E-Moped you are interested in Hiering?*

CPX with 2 Batteries + Super Charger (80+ Miles approx) £80 p/w plus £150 Deposit.V2 with 1 Battery + Charger (49 Miles approx) £60 p/w plus £150 Deposit.
Do you have experience with electric mopeds?
Will you be keeping the E-Moped at your registered address?*
Full address/location of where you will be keeping the vehicle

State / Province
Driving Licence & CBT Details

For Driving License information (points confirmation), please request using https://www.gov.uk/view-driving-licence (valid for 21 days). you will need your driving licence number and National Insurance number.
Photo of your license*: FRONT
or upload Scan of the FRONT of your license:

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Photo of your license*: BACK
or upload Scan of the BACK of your license:

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Have you made a vehicle Insurance claim in the last 3 years?*
How Many Points do you have on your License?*
Your National Insurance Number?*
CBT Certificate

Please remember to bring your ORIGINAL CBT on the day you present your documents. We can only release the Moped with Original Documents.
Please take a photo of your valid CBT*:
or upload a scan of your valid CBT:

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Delivery App Information (optional info)
Wich Delivery Apps do you most work for? (click as many as you like)

DeliverooJust eatUber EatsHungry HouseQuiqupZomatoFood HubTalabatOther
if other, which delivery platform do you work for?
Payment Details (we use Stripe as our payment provider)

Bellow please make sure you select the e-Moped type you want to rent and the day of the week you want to pick up. 🚀

Select you e-Moped rental:

e-Moped CPX Rental Pick-Up + Deposit

Super Soco CPX e-Moped rental. Deposit of £150 plus X days at £11.50 per day. Then £80 per week the following Tuesday until canceled.

£230.00
Item subtotal:£0.00

e-Moped VS2 Rental Pick-Up + Deposit

VMOTO VS2 e-Moped rental. Deposit of £150 plus X days at £8.50 per day. Then £60 per week the following Tuesday until canceled.

£210.00
Item subtotal:£0.00

Battery Swap (Camberwell SE5)

Never loose power with our ONE Battery swap feature between the hours of 09:00 and 20:00 (Price is an optional extra paid Per Week)

£15.00 Quantity
Item subtotal:£0.00

Total

£0.00

Payment Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

You confirm that the information provided in this form is true and accurate. Please note that any false or inconsistent information may result in the rejection of your application.

To facilitate the release of the e-Moped on the day you pick up, you must bring the original copies of the following documents:
- Your valid UK Driving Licence
- Original and valid CBT certificate
- Proof of address (e.g., an official document or bill in your name showing your address)
Signature
Should be Empty: