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Appointment Request Form

If possible, I'll repair your bike on the spot when I arrive!
However, larger repairs and repairs involving replacement parts may require me to hold onto your bike for a bit.
Please click the button below for info on my pickup/drop-off rates.

Pickup & Drop-Off Pricing

* Indicates required field

How would you prefer to arrange the hand-off? *

I need you to pick my bike up. I'd prefer to have my bike serviced at my home*

Personal Contact Info:

Name *

First

Last

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

I prefer *

Texts Calls Either

Information about your bike:

Do you have multiple bikes that need servicing? *

No Yes

If yes, please either: Submit two repair request forms OR include a brief description of additional bicycles in the "Additional Details" field below.

Bicycle Year *

If you don't know the exact year, give me your best guess. This information helps me determine parts compatibility and cost estimates.

Bicycle Manufacturer *

Bicycle Model *

This information helps me determine parts compatibility and cost estimates.

Bicycle Type *

Is this bicycle motorized? *

I'd like to schedule a(n)... *

Select any and all issues that apply to your bike: *

Braking Shifting Tire(s)/Tube(s) Headset Bearings Wheel Bearings Bottom Bracket Bearings Excessive noise while pedaling Excessive noise while braking Front Suspension Rear Suspension Unsure None Other (Please describe below)

Additional Details *

Please include a short summary of your concerns about and desires for your bike.

Submit

Eternal Cycle Works, LLC. Last Updated:6-6-2020