Courtesy Car Form

Schedule Service

Duke Collision is proud to offer a Free complimentary courtesy car—when available—to customers who are self-paying or do not have rental car coverage. Vehicles are limited, so a prior appointment is required.

3728 Overlook Rd,
Raleigh, NC 27616

(919) 803-8300

Mon – Fri: 9AM – 5PM
Closed Weekends

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This field is for validation purposes and should be left unchanged.

Courtesy Vehicle Information:

Year(Required)

Make(Required)

Model(Required)

Color(Required)

Mileage

Out(Required)

In(Required)

To Be Returned(Required)

Customer Info

Name(Required)

Driver's License #(Required)

Insurance Company(Required)

Expiration Date

Policy Number(Required)

Date

BY SIGNING BELOW, I HAVE READ AND AGREED TO THE TERMS OF THIS COURTESY VEHICLE(Required)

I agree

THE RECIPIENT OF THIS COURTESY CAR ACKNOWLEDGES THE FOLLOWING RESPONSIBILITIES AS EXPRESS CONDITIONS FOR THE USE AND OPERATION OF SAID COURTESY CAR: THE RECIPIENT’S INSURANCE IS PRIMARY AND WILL BE RESPONSIBLE FOR ANY AND ALL DAMAGE AND LIABILITY ARISING OUT OF OR IN ANY WAY RELATED TO THE USE AND OPERATION OF THIS COURTESY CAR. THE RECIPIENT WILL BE RESPOSIBLE FOR ANY AND ALL DEDUCTIBLES AND EXPENSES NOT COVERED BY HIS/HER INSURANCE. THE RECIPIENT IS AT LEAST 18 YEARS OF AGE OR OLDER AND HOLDS A VALID DRIVER’S LICENSE. THE RECIPIENT AGREES TO PAY A REFUELING FEE OF $30.00 IF COURTESY VEHICLE IS NOT RETURNED TO A FULL TANK. THE RECIPIENT AGREES TO BE RETURN THE LOANER VEHICLE WITHING 24 HOURS OF ONCE THEIR VEHICLE IS COMPLETED WITH REPAIRS, A FEE OF $60.00/DAY. WILL BE DIRECTED AND NOTED VIA MAIL MESSAGES/TEXT. NO SMOKING IN THE VEHICLE I hereby entirely assume sole and absolute responsibility and liability for any damage to the vehicle described above and owned by Duke Collision and for any and all damages, loss, expense, fee and/or claim resulting from or relating to the operation of said vehicle while it is in my possession or under my control. I have motor vehicle liability insurance coverage which complies with the State of North Carolina minimum liability requirements and is sufficient to provide primary first vehicular coverage against any and all losses, damages, expense, fee and/or claim and hereby agree to indemnify and hold Duke Collision harmless from and against any and all losses, claims, damages, expenses and/or fees, including attorney’s fees, related to my possession of said vehicle while it is in my possession or under my control. The customer agrees to meet the cost of any traffic infringement and or lawful charges and fees Incurred during the agreement period and agrees to pay all fines, toll fees and charges imposed as a result thereof. The customer agrees that the vehicle will be returned in a reasonably clean/smoke free condition, and failure to do so will result in the customer being charged for the expenses pertaining to the cleaning of the vehicle. The customer agrees is Prohibited use of the vehicle for transporting people or property for hire (example taxis, uber, lyft any other similar) The customer agrees he/she will be the only driver of the vehicle and will drive the vehicle in a safe manner with accordance with the NCDMV road rules. *Please Note: in the event of an accident/incident the full excess will be charged to the customer regardless of fault, if deemed the customer was not and fault and the at fault party can be identified the excess will be refunded in full The customer MUST return the vehicle to Duke Collision ONLY.

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