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Rental Application

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Please Select an Instrument Option:

Previously-Rented or Brand New? *

Brand New

Previously Rented

School Lessons Start Date

*If your child is signed up for summer school lessons, please select "Summer Lessons" below and provide the first lesson date.

**Starting dates are typically provided by your music teacher either in a paper information handout/flyer or in an email.

*

Beginning of upcoming school year (Fall semester)

Summer School Lessons (provide start date below)

Student Information:

Name: Last, First, Middle Initial *

Grade Attending in Fall *

Music Teacher's Name *

School District *

School Building *

Home Address (if different)

Primary Account Contact:

Name: Last, First, Middle Initial *

Relation To Student *

Home Street Address *

City / Town *

Zip Code *

Phone *

Email *

Driver's License Number & State *

(example: 123-456-789 NY)

Employer Name *

(Full business name, no abbreviations or acronyms. If self-employed, please list full name of business)

Current Position *

Employer Street Address *

City / Town *

State / Zip Code *

Work Phone or Cell *

Work Email

Secondary Account Contact:

If Home Address information is same as Primary, type "SAME" in Address fields.

Name: Last, First, Middle Initial *

Relation To Primary *

Home Street Address *

City / Town *

Zip Code *

Phone *

Email *

Driver's License Number & State

(example: 123-456-789 NY)

Employer Name *

(Full business name, no abbreviations or acronyms. If self-employed, please list full name of business)

Current Position *

Work Phone or Cell *

Accessories (Please select items for delivery with your instrument)

Reeds (Brand & Strength)

Rico 10-pack / 2.5 (+$22.95)

Rico Royal 10-pack / 2.5 (+23.95)

Mitchel Laurie / 2.5 (+$25.95)

Vandoren / 2.5 (+$33.95)

Other

Care Kit

Care Kit (+$17.50)

Contains the essential accessories for keeping your instrument in great playing condition.

Music Stand

Music Stand (+$16.95)

Necessary for proper posture while practicing at home.

Lesson Book

Click Your Required Lesson BookUnsure At This TimeAccent on Achievement Bk. 1 ($11.99)Accent on Achievement Bk. 2 ($11.99)Band Expressions Bk. 1 ($8.99)Breeze Easy Bk. 1 ($8.99)Breeze Easy Bk. 2 ($7.95)Ed Sueta Bk. 1 ($8.95)Ed Sueta Bk. 2 ($8.95)Essential Elements for Band Bk. 1 (NEW EDITION) ($14.99)Essential Elements for Band Bk. 2 (NEW EDITION) ($14.99)Foundations for Superior Performance ($6.95)Measures of Success Bk. 1 ($9.95)Rubank Elementary Method ($7.99)Rubank Intermediate Method ($7.99)Student Instrumental Course Bk. 1 ($7.99)Student Instrumental Course Bk. 2 ($7.99)Standard of Excellence Bk. 1 ($8.50)Standard of Excellence Bk. 2 ($8.50)Standard of Excellence ENHANCED Bk. 1 ($12.99)Standard of Excellence ENHANCED Bk. 2 ($12.99)Yamaha Advantage Bk. 1 ($8.95)Yamaha Band Student Bk. 1 ($7.99)Tradition of Excellence Bk. 1 ($12.99)

Other Brand & Strength

Payment Information:

This is the card that will be charged for the initial payment and subsequent recurring monthly installments. If necessary, this card can be changed at a later date by speaking with our accounts department.

Name On Card *

Card Type *

Visa

Mastercard

Discover

Card Number *

(example: 1234-1234-1234-1234)

Expiration Date *

(example: 09/27)

3-Digit Security Code *

*

IMPORTANT! PLEASE READ TERMS AND CONDITIONS FULLY BEFORE AGREEING
LEGAL INFORMATION - NYS PENAL LAW REGARDING NON-PAYMENT AND REFUSAL TO RETURN RENTAL PROPERTY

I read, understand, & agree: Terms and Conditions

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