Title: select Ms Mrs Miss Mr Dr Rev Other

First Name:*

Surname:*

Address 1:*

Address 2:

Town/Village:*   Post Code:*

Daytime Telephone Number:*

Email Address:* (e.g.: fred@bloggs.com)

Preferred Date: Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2010 2011 2012

About Your Bike

Type:

Adult's Bicycle
Child's Bicycle
Adult's Tricycle
Tandem
Recumbent Bike/Trike
Other
Wheel/s Only

Make: (e.g.: Dawes)

Model: (e.g.: Discovery 301)

Work Required

General Servicing:

Single Geared Bike Service (£20.00)
Bronze Bike Service (£40.00)
Silver Bike Service (£50.00)
Gold Bike Service (£85.00)

Wheels:

Front Wheel Puncture
Rear Wheel Puncture
Fit New Tyre/s
True Wheel - replace broken or damaged spokes as required
Fit New Wheel Bearings

Bike Cleaning:

Yes, I would like my bike cleaned (£15.00)

(NB. Where we have to clean a cycle in order to properly assess, or carry
out, the work required we reserve the right to levy a cleaning charge.
This will apply even if you have indicated on this form that you do not wish
your cycle to be cleaned. If it is likely that this condition will apply, you
will be informed when you bring your cycle to the shop)

Additional Information
Please use the space below to tell us about any work required not covered
by the items above. If you're unsure about the work required, you can use
this space to describe the problem.

enter any additional information here please ...

* I accept the Repairs & Servicing Terms and Conditions (opens a new tab or window)

Click the Submit button once to send your booking request.