Battery Intake Form

BATTERY SERVICE INTAKE FORM

 Copy and Print this page to send this into RPE with any battery for rebuild quote 

INSTRUCTIONS FOR SHIPPING: Please send the BATTERY and CHARGER using a corrugate box. Secure the battery and charger with internal protection, making sure battery does not have room to move during transit. Close your container securely and display the dangerous goods label that is provided, on the outside of your package. Send via GROUND shipping with your preferred shipper.

Name: ________________________________________________________________________________________________________________

Phone: ________________________________________________________________________________________________________________

Email: _________________________________________________________________________________________________________________

Street:  ________________________________________________________________________________________________________________

City, Street, Zip: ______________________________________________________________________________________________________

Ebike Information

Make: __________________________________________ Model: ______________________________________ Year: ____________________________

Description of Problem: ________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________

Battery Information

Brand/Manufacturer: ______________________________________________ Voltage (May be a range) ______________________________

Wattage (May be a range): ____________________________ Amperage (May be a range)_________________________________________

Serial Number: ________________________________________________________  Mfg. Date:_____________________________________________

Description of Problem:­­­­­­­­­­­_________________________________________________________________________________________________________

____________________________________________________________________________________________________________________________________

 

Are you interested in an upgrade if possible? ­­­­­­­­­________________________________________________________________________________

 

ATTACH THIS DANGEROUS GOODSLABEL TO SHIPMENT

 

 

Send Ground To:
Ebike Market Place
6585 Arville Street, Suite A
Las Vegas, Nevada 89118