Form

Phone

First Name

Last Name

Street Address

City

State/Region

Zip Code

Moped or Scooter Make & Model

Please select the option that best describes the issue you are having with your scooter or moped.

Please describe the issue as best you can..

Do you have any photos of the issue you would like to add?

Please select any and all that apply:*

I will need just pick-up service.

I will need pick-up and delivery service.

I do need a loaner moped or scooter while you wait.

I will bring the scooter or moped to the shop myself.

I'm not sure if i will need any of these.

If you need the pickup or delivery service please use this field to select the date and we will contact you. If you are planning to bring the scooter to the shop yourself please select the date you would like to bring it by to help us better serve you!

Year/Month/Day