Pickup Details
 
 
 
 
Full Name*
 
 
 
Email Address*
 
 
 
Mobile Phone*
 
 
 
Street Address*
 
 
 
Street Address 2
 
 
 
City*
 
 
 
Province*
 
 
 
Postal Code*
 
 
 
 
 
 
 
 
E-Bike Device Information
 
 
 
 
E-Bike Brand*
 
 
 
E-Bike Model
 
 
 
E-Bike Serial Number
 
 
 
Is the e-transport product damaged in any way that will require additional safety precautions?*
 
Yes
No
 
 
If yes, please describe damage:
 
 
 
 
 
If you live in a condo or apartment with a specific protocol for pick-ups/deliveries, please leave specific instructions below. Please include any other pertinent pick-up instructions. 
 
 
 
 
Special pick-up instructions
 
 
 
 
 
Please attach a photo of the device. *