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:
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