The experience is much like everywhere else. You go to the counter, you sign a contract, and you get the keys to the car.

Watch your confirmation, it may say you need an international drivers license.

if you don't like what they charge, there are many other rental agencies to choose from.

In Tuscany, make sure you understand the areas that you are not allowed to drive into. Usually the old town centers, sometimes clearly marked, sometimes not. If you cross someplace where you are not supposed to go, expect a hefty ticket in the mail down the road.