Band Instrument Rental Applicaion

Band Instrument Application: 4 equal payments

Please enter all requested fields.
Name*

First NameLast Name
I can verify that I am over the age of 18*

YesNo
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Contact Information
State Issued Driver's License / ID info*
Please enter issuing state
Drivers License / ID number *
Please enter your ID# not the state of issue
E-mail*
example@example.com
Primary Phone #*
Secondary Phone #*
Must be different than primary

Employment Information
Work Or Business name *
If retired, enter "retired"
Status of employment.*

Business Owner / Self Employed or SubcontractorEmployedRetired.Unemployed.
How long have you been at this location? *
Title or position*
Tax ID or EIN Number
Please do not enter your Social Security Number!
Work or Business address*

Street Address

Street Address Line 2

CityState

Zip Code
Business / Work Phone Number*
Must be different than Primary or Secondary Unless self employed
Please do not enter your Social Security number in the box above.

This can be found on your state issued Business License.
Your EIN number will be issued to you by the state and can be found on your Federal Income tax paperwork.

Name of student using the instrument*
This information will not shared or sold!
Your relationship to the student who will be using the instrument.*
Will this be the first year your child has been in the schools band program?*

YesNo
How many previous school years has the student been involved in band?*

School Delivery or In Store Pick Up*

Please Deliver to my child's schoolI will pick up at Harris Band Instruments

AUTOMATIC DRAFT IS REQURIED FOR ALL MULTIPAYMENTS.
I can verify the credit / debit card I provide is a valid credit / debit card attached to my personal bank account. It is not a pre-paid, payroll, or government assistance card.*

Yes

Terms and Conditions
I agree with the terms and conditions listed here. I have been provided and read a copy of all terms and conditions. Please scroll to bottom to go to next screen.*

Yes
Signature

Clear
AUTOMATIC DRAFT IS REQURIED FOR ALL MULTI-PAY CONTRACTS.

By signing this online document, the purchaser authorizes Harris Band Instruments to automatically debit credit card on file each month for the amount stated in the contract for each month until balance is paid in full. If for any reason the credit card on file changes, it is the responsibility of the purchaser to contact Harris Band Instruments.

If the credit card on file is declined a $20 late fee will be assessed to the account. Harris Band Instruments LLC will attempt to contact the purchaser to make payment arrangements. If the purchaser can not be contacted Harris Band Instruments LLC will continue to attempt to collect payment using the credit /debit card listed here until the account is brought up to date.

If the account becomes over 60 days past due, the lessee hereby grants Harris Band Instruments, LLC permission to retrieve the instrument. The instrument may be returned to the lessee upon the account being brought up to date, including late fees, and a valid credit / debit card is placed on file.

THIS AGREEMENT IS SUBJECT TO ADDITIONAL PROVISIONS SET FORTH LISTED BELOW. THE SAME BEING INCORPORATED HEREIN BY REFERENCE.
NOTICE TO PURCHASER (1) YOU ARE ENTITLED TO A COPY OF THIS CONTRACT. KEEP IT TO PROTECT YOUR LEGAL RIGHTS. (2) RECEIPT OF A COPY OF THIS SECURITY AGREEMENT IS HERBY ACKNOWLEDGED (3) CAUTION IT IS IMPORTANT THAT YOU THROUGHLY READ THIS CONTRACT BEFORE YOU SIGN IT.
Contract Terms:
·        This agreement between Harris Band Instruments hereinafter called the Seller, and the undersigned, hereinafter called the Purchaser is entered into this day.
·        Whereas the purchaser agrees to purchase the above described musical merchandise from the Seller for the amount indicated per month. The first month payment is payable at the time the instrument is received and in advance monthly thereafter until the purchase price including sales tax is reached.
·        The Seller warrants that the condition of said merchandise as received and hereby acknowledged by the Purchaser.
·        The Purchaser agrees not to remove said merchandise from the county of his or her address, without express permission of the Seller
·        The Seller shall not waive any rights under this contract whatsoever, by reason of any delay in enforcing the same
·        The title of said merchandise shall remain with the Seller until the full amount of the purchase price is paid, at which time the Seller will issue a clear bill of sale for the same.
·        Payments must be made on the due date. Any payment received after the due date will cause the account to be considered in default.
ADDITIONAL TERMS AND CONDITIONS
ADDITIONAL TERMS AND CONDITIONS

NO INSURANCE PROVIDED.

THERE ARE NO WARRANTIES, WITH RESPECT TO GOODS PURCHASED HEREUNDER, EXPRESS OR IMPLIED OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR OTHERWISE, UNLESS THEY ARE IN WRITING SIGNED BY SELLER.

Purchaser agrees that no assignment of this agreement, or any interest hereunder, or loss, damage, injury or destruction of goods shall release the purchaser from his obligations hereunder, to keep the goods free of all taxes, liens, and encumbrances; to take good care of the goods and maintain them at purchaser’s address shown on the face hereof; not to transfer any interest in the goods without the prior written consent of the Holder hereof; that all rights of exemption in Homestead and other laws except as to garnishment are hereby waived; that Holder is authorized to correct patent errors in the Agreement’ that Seller’s assignee is entitled to all rights of Seller.

Time is of the essence of this agreement. If the Purchaser defaults as to any obligation hereunder, then the entire indebtedness shall become immediately due and payable, and Seller may without notice, demand, or by legal process, take possession of the merchandise wherever located and retain all monies paid thereon for use of said merchandise. Purchaser agrees to pay all reasonable expenses incurred by the Holder in connection with any repossession, or sale of the goods or otherwise incurred by reason of the purchaser’s default, and when the unpaid balance after default exceeds $300.00 the Buyer further agrees to pay a reasonable attorney’s fees provided the attorney is not a salaried employee of the Holder, except that in no event shall attorney’s fee exceed fifteen percent (15%) of the unpaid balance after default. All notices or statements required to be given to Purchaser shall be properly given if mailed to Purchaser address shown on the face hereof.

Purchaser certifies that the credit information furnished by him/her in connection with this sale is true. In the event that the goods sold hereunder become fixtures by operation of law or otherwise, Purchase and Seller agree that the security interest in such goods shall not extend to, or become a security interest in, any real property which is used as the principal residence of the Purchaser.

Purchaser authorizes Seller and any signee of this contract to release to credit bureaus; credit interchanges and other grantors of credit such information relating to this transaction and Purchaser’s creditworthiness, as may be pertinent to Seller.

This Agreement constitutes the entire agreement between the parties and shall be binding upon and insure to the benefit of the parties and their respective heirs, representatives, executors, administrators, successors and assigns. Any provision of this Agreement which is prohibited without invalidating the remaining provisions of this agreement.

The holder here of may amend this agreement from time to time and will mail to the Buyer at Buyer’s address last known to the Holder written notice of any such changes not less than 30 days prior to their effective date, unless a longer notice period is required by law.

Thank you. A representative from Harris Band Instruments will contact you shortly. Please indicate the best time we can contact you as well as any questions or concerns you may have.
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This step will finialize this application. Please print or save the next screen for your records. A verification will be sent to the e-mail address you privided.
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Band Instrument Application: 4 equal payments