E-BIKE CONVERSION EVALUATION NAME * First Name Last Name EMAIL * CELL PHONE | CONTACT NUMBER * LOCATION IN SOUTH AFRICA * Area / City / Province MAIN REASON FOR RIDING AN E-BIKE * FUN AND ADVENTURE EXERCISE EXERCISE, FUN AND ADVENTURE COMMUTING / TRANSPORT STICKING TOGETHER WITH FRIENDS & FAMILY ON RIDES HEALTH OR MEDICAL REASONS DELIVERIES OTHER MAKE AND MODEL OF BIKE YOU WANT TO CONVERT FOR EXAMPLE : GIANT (BRAND) ANTHEM (MODEL) YOUR FRAME SIZE SMALL (15") ; MEDIUM 17" ; LARGE (19") , EXTRA LARGE (21") HEIGHT * in inches or meters or centermeters WEIGHT * in Kilograms (KG) TERRAIN * What type of terrain will you be primarily riding on? Heavy Off-Road & Single Tracks Light Off-road On-Road Combination of Heavy Off-road & On-Road Combination of Light Off-road & On-Road Mainly Beaches and/or Sand dunes GRADIENT * Please give us an indication of the steepness of the gradient that you intend to mainly ride on. VERY STEEP. MEDIUM STEEP. MOSTLY FLAT WITH LIGHT HILLS. COMBINATION VERY STEEP AND MEDIUM STEEP. COMBINATION MEDIUM STEEP AND FLAT. MOSTLY FLAT. AVERAGE DISTANCE * What would you estimate that your average cycling distance per day will be? Less than 30KM 30-50KM 50-70KM 70-90KM More than 100KM POWER * Please give us an idea of the amount of power that you would feel most comfortable with. HIGH POWER - I WANT TO HAVE MORE THAN ENOUGH POWER. MEDIUM POWER - ENOUGH TO COVER MOST STEEP HILLS PLUS A LITTLE MORE JUST IN CASE. ENOUGH POWER TO KEEP UP WITH FRIENDS ON RIDES. PREFERRED E-DRIVE SYSTEM * If you have a particular motor system that you prefer, please let us know. FRONT HUB EDRIVE SYSTEM ( MOTOR IS IN THE FRONT WHEEL) REAR HUB DRIVE SYSTEM ( MOTOR IS THE REAR WHEEL ) MID DRIVE MOTOR SYSTEM ( MOTOR IS IN THE CRANK BETWEEN THE PEDALS) NO SPECIFIC PREFERRED SYSTEM. YOUR LEVEL OF FITNESS * VERY FIT MEDIUM FIT UNFIT MEDICAL / HEALTH MATTERS PLEASE LET US KNOW IF YOU HAVE ANY SPECIFIC NEEDS MEDICALLY OR HEALTH-WISE THAT WE SHOULD PAY ATTENTION TO. BUDGET * R40-50K R50-60K R60-70K R70-80K Thank you for taking the time to answer the questions above. We look forward to contacting you soon to embark on a new journey together. Many Thanks, The Chilled Squirrel Team Thank you for your submission!We will be in contact with you as soon as we have reviewed your form.