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Loaner Form
Please fill this form out carefully. You may bring printed form to any of our Virginia Stores along with the vacuum that you would like us repair.

Important: We will need at least 2 forms of identification to provide you a loaner
Vacuums Unlimited
474 Elden Street
Herndon VA 20170
(In K-mart Shopping Center)
703-471-7979
Vacuums Unlimited
Chantilly
14500 Lee Rd Suite G and H
Chantilly Va 20151 703-961-1740
 warehouse@govacuum.com
Map & Driving Directions Map & Driving Directions
Name:
Address:
City: State:
Zip: Home Phone:
Work Phone: Fax:
   
Brand of Vacuum: Model# (if known) :
Serial# (if known) :
Problem with vacuum:
How old is the vacuum?
Additional Comments:
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