Fleet Incident Request Form

Instructions:

1. Please ensure your Site Code is correct as we will use this in our planning

2. Either enter the Mopeds Registration Number OR the Eskuta Bike Number, not both

3. If the bike is NOT at your Site, please ensure you enter an address. Otherwise we will assume it is at your location referenced by the Site Code.

4. The more information provided, the easier it will be to help you. This is particular important for damage reports. In this case, it is particularly important to provide as many photos as possible.

* Denotes Required Field

Site *

Enter your name *

Are you? *

The Person Reporting the issue to us only?

The Rider of the bike at the time the issue was encontered?

Both

Enter your Phone number *

Enter your email *

Vehicle Reg Number

Or

Eskuta - Bike Number

Bike Usable? *

Yes

No

Description of Issue - Please include as much information as possible *

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Fleet Incident Request Form

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