AGREEMENT
Temporary Loan of Motor Vehicle
Borrower’s Name:_______________________________________________
Today’s Date:_________ Date to be Returned: __________ By 6:00pm CST
Stock Number:_________________________ Plate Number:_____________
Vehicle Year, Make, Model:_________________________________________
Mileage Out:_____________________ Fuel Level:
¼
½
¾
Full
Released By:___________________________ Time:____:____ a.m./p.m.
Inconsideration of: Tommy’s Quality Used Cars (hereafter called the Lender) loaning me the above
described motor vehicle, I hereby accept full responsibility for its operation and agree that I will not operate it
contrary to the Law’s of any jurisdiction in which it is being operated. I also agree to indemnify and hold
harmless said Lender for any claim of claims of personal injury or property damage to others or myself
arising out of the use or operation of said vehicle. I further agree not to allow anyone else to drive the said
vehicle and deliver it to the Lender on or before the date specified above for its return in as good mechanical
and physical condition as when it was loaned to me, or pay the Lender immediately for any repairs
necessary to restore said vehicle to the same condition when I received it. In the event of any accident
involving said vehicle I will within 12 hours following such accident, furnish Lender and will also hold Lender
harmless and indemnified for any damage, cost or expense in connection therewith. I also agree that I will
not authorize or incur expenses of any nature whatsoever for the repair of said vehicle, that I will bear all
expense incidental to its maintenance, and I will hold harmless and indemnified the Lender against all claims
and demands, including parking tickets arising or resulting from the use, storage and/or repairs of said
vehicle during my custody of same. It is expressly understood by me that I have the permission of the
Lender to operate said vehicle only during the period above stated and If I operate said vehicle beyond the
time specified for its return, I do so without the permission of the Lender. If said vehicle is stolen from my
custody, I will immediately notify said Lender of such theft but shall not be otherwise liable for the return of
the said vehicle with respect of its operation after such theft. I am aware that I am the only driver that has
permission to drive this vehicle.
If any prevision herein shall conflict with or have effect of depriving any of the parties of the benefit of any
insurance coverage applicable in the absence of such prevision then such prevision shall not be effective
and it void, but the borrower shall remain subject to all other legal liabilities imposed by this agreement by.
I represent that I am duly authorized to operate a motor vehicle in the State of
______________ and my Operators License Number is:_________________, with a
expiration date of______________________.
I am currently insured under an automobile liability policy issued
by: ____________________________, Policy Number: _______________________
Customer (borrowers) Signature: _________________________________________
424 State Street, Guthrie KY, 42234