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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
    14500-G Lee Rd.
    Chantilly, VA 20151
    Located at Rt. 50 and Lee Rd. (west of the Rt. 28, Rt. 50 interchange), opposite Costco Wholesale.
    (703) 961-1740
    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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