Govacuum.com

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
11217C Lee Highway
Fairfax VA 22030
(Next to Chili's Retaurant Corner
of Lee Highway and Germantown Road)
703-273-6688

Vacuums Unlimited
474 Elden Street
Herndon VA 20170
(In K-mart Shopping Center)
703-471-7979

Vacuums Unlimited
171 Maple Ave. East
Vienna, VA 22180
(Next to Fresh Fields Supermarket Corner of Maple Avenue and Park Street)
703-938-5363

Vacuums Unlimited
201 Davis Dr. Unit C
Sterling VA 20164
(opp. Chevron/Sweet ater Carwash)
703-773-1220

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: