Get a Loaner Car | Midas of Richmond

Please review Midas of Richmond’s full loaner car agreement (PDF) and then complete the form below to get started.

VIEW FULL LOANER CAR AGREEMENT

Midas Loaner Car Form

Name

First

Last

Address

City

State/Province

Zip/Postal

Country

Phone #

Choose Your Store

Date of Appointment

Name of Insurance Company

Expiration Date of Insurance

Please confirm the following:

Customer confirms that they have FULL coverage insurance (liability AND physical damage coverage).

Customer agrees that their insurance will be the primary coverage for the vehicle in the event of an accident.

Customer agrees that they are responsible for a cleaning fee if they smoke or have pets in the vehicle.

Customer agrees they will be charged a $50/day rental fee if the vehicle is not returned within 24 hours of the work being completed.

Customer agrees to pay any toll violations, parking fines, or other fees incurred while using the vehicle.

Upload Driver's License

Maximum file size: 10MB

Upload Insurance Card

Maximum file size: 10MB

Questions or Comments?

Signature

Clear

Signing confirms that you have read the agreement.

Date

If you are human, leave this field blank.

Willow Lawn

5301 W. Broad St.
Richmond, VA 23230
804.288.4055

Scott's Addition

1212 N. Arthur Ashe Blvd.
Richmond, VA 23230
804.256.0200

Short Pump

11463 W. Broad St.
Richmond, VA 23233
804.360.2211

Church Hill

2018 E Broad Street
Richmond, VA 23223
804.554.3198

Midlothian

10160 Hull Street Rd.
Midlothian, VA 23112
804.276.9600

Colonial Heights

1400 Boulevard
Colonial Heights, VA 23834
804.520.2206

Loaner Car Agreement