Dealership Loaner Vehicle Agreement and Damage Disclosure

Captures driver license, insurance, mileage, fuel level, and pre-existing damage when issuing a service loaner, including personal data wipe acknowledgment.

Agreement Overview

• Agreement Date
• Service Advisor Name
• Customer Name
• Loaner Vehicle Year, Make, and Model
• What happens after I submit?

Driver and Insurance Information

• Driver License Number
  Enter the license number only. Avoid collecting additional personal data unless required by policy.
• Issuing State / Province
• Insurance Provider
• Policy Number
• Insurance verified by staff?

Vehicle Condition at Checkout

• Odometer Reading
  Enter the mileage shown on the vehicle at checkout.
• Fuel Level
• Is any pre-existing damage visible?
• Damage Type(s)
• Damage Description
  Describe the location and extent of each visible issue.
• Damage Photos

Personal Data Wipe Acknowledgment

• Personal data wipe or privacy check completed?
• Was any stored personal data found?
• Wipe / Privacy Check Notes
  Record any exceptions, such as paired phones, navigation favorites, garage codes, or other stored data removed.

Customer Acknowledgement

• I have reviewed the vehicle condition and agree to the loaner terms.
• Customer Signature
• Staff Signature