I understand and agree that my personal insurance extends to this vehicle as Primary coverage and that I have comprehensives and collision coverage on my policy. Please provide following information and photocopy of identification cards.

Insurance Carrier

Policy #

California Driver's License #

Both are in force and valid at this time. I agree that I am the only person to drive this loaner vehicle and that I am not permitted to allow anyone else to drive it.

Customer Name Print

Customer Signature

Rpm Automotive Services is committed to ensuring effective communication and digital accessibility to all users. We are continually improving the user experience for everyone, and apply the relevant accessibility standards to achieve these goals. We welcome your feedback. Please call Rpm Automotive Services (707) 584-8230 if you have any issues in accessing any area of our website.