Home

UCAR Blue Bike Fleet Maintenance Request Form

Who is submitting this maintenance request?

First Name : Last Name : Email : Phone :
Which bike needs maintenance? Other Name:
Bike Location

Other Location

Problem areas

Brakes	Drive Train	Wheels	Tires	Misc
Out of adjustment Bad cables or housing Broken parts Hard to explain	Needs shifter adjustment Needs cables or housing Broken rear deraileur Broken front deraileur Hard to explain	Bent front wheel Bent rear wheel Front broken spokes Rear broken spokes Bad hub front Bad hub rear Hard to explain	Front flat Rear flat Replace rear Replace front	Fenders Bell Cargo rack Grips Seat Reflectors Bottle cage Pedals

Please describe any additional problems :