Vacuums
Unlimited Loaner Reservation Form |
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Please fill this form out carefully. You are required
to bring the printed form to any of our Virginia Store physically along
with the Vacuum to be repaired.
Important: We will need atleast 2 ID's to provide you a loaner. |
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| Name: | _________________________________ | ||
| Address: | ______________________________________________________________________________________ | ||
| City: | _________________________________ | State: | _________________________________ |
| Zip: | _________________________________ | Home Phone: | _________________________________ |
| Work Phone: | _________________________________ | Fax: | _________________________________ |
| Brand of Vacuum: | _________________________________ | Model# (if known) | _________________________________ |
| Serial# (if known) | _________________________________ | ||
| Problem with vacuum: | |||
__________________________________________________________________________ __________________________________________________________________________ |
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| How long you have this vacuum with you?: | |||
| _________________________________ | |||
| Have You considered trading it with another vacuum?: | |||
| Yes No | |||
| Your Comments: | __________________________________________________________________________ |
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