Servicing Form Mopeds

Model

Plate Number

Location

Km

Miles

Light /Headlamp orientation —Please choose an option—CleanedAdjustedReplaced
Front brake Fluid —Please choose an option—CheckedRefilled
Front brake pad wear —Please choose an option—Cleaned and CheckedReplaced
Rear brake fluid —Please choose an option—CheckedRefilled
Rear brake pad wear —Please choose an option—Cleaned and CheckedReplaced
Rear brake shoe wear —Please choose an option—CleanedChecked and AdjustedReplaced
Transmission belts —Please choose an option—CheckedReplaced
Muts, bolts, fasteners —Please choose an option—Checked
Stand —Please choose an option—Checked and Lubricated
Steering Bearing —Please choose an option—Checked
Front Tire —Please choose an option—100%80%60%40%20%Changed
Files* (please add pictures of the front Tire)

Rear Tire —Please choose an option—100%80%60%40%20%Changed
Files* (please add pictures of the rear Tire)

Otto Scooter Resp
Name and Surname
Otto Scooter Resp Signature ↓

Hirer
Hirer Company
Hirer Resp Name and Surname
Hirer Resp Signature ↓

Note