RCMR Loan Car information form
**Please do not fill this form out before you arrive as the car you select cannot be guaranteed for you to use**


This short form is to be filled out each and every time a loan car is taken from us. It allows us to ensure you are insured during the time you have the car.
Email address *
Full name *
Your answer
Date of birth
MM
/
DD
/
YYYY
Drivers Licence number
Your answer
Terms and conditions
1. Where the car is covered by our insurance, the customer will be liable for the excess. Under 25’s and over 70’s £750, all others £500.
2. The car is loaned with 3rd party insurance only.
3. The car has valid road tax, is serviced annually and MOT tested.
4. We cannot be responsible for any costs incurred in the unlikely event of a breakdown; however we must be notified in the event of such.
5. You accept full responsibility for any uninsured loss or damage however caused. In the event of an accident we must be notified immediately. Any repair works will be carried out by us and the driver will be responsible for payment of the invoice.
6. You accept that any motoring or traffic offences, tolls or penalties etc. relating to the loan period will be the sole responsibility of the driver under the Road Traffic Regulation Act 1984, the Road Traffic Offenders Act 1988 and/or any future legislation.
Your contact details will be passed onto the relevant authorities by default
7. The car will not be driven any more than 150 miles per day of loan without prior agreement.
8. The car has been loaned with fuel, we ask that it is returned with approximately the same amount when returned.
Please don't bring it back on fumes as this is unfair for the next person.
9. The vehicle will be insured for the named person above only to drive. Any other drivers must read and submit a separate form.
We can email you a link to this form for additional drivers to fill out if necessary.
10. The vehicle must be returned in a satisfactorily clean condition or a valet fee will be charged of £50.
11. The vehicles have a strict no smoking and no animal policy.
Loan car details *
Terms and conditions agreement *
Yes
No
Confirm you have read, understood and agree with all the terms and conditions
Are you happy for us to use your contact information for vehicle and appointment reminders and notifications from RCMR?
A copy of your responses will be emailed to the address you provided.
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