Online Rental Form

School*

Student's School (please use Brass Bell for non-school rentals)

Teacher

Student's band, orchestra, or private lessons teacher

Student Name*

First NameLast Name

Instrument*

Instrument Level (pricing listed below)*

Standard: Used Instrument, Mechanically Great, Cosmetically fairPreferred: Used Instrument, Like New, Mechanically Great, Cosmetically GoodNew: Brand New Instrument, Never Rented or Sold

Band Instrument Pricing

Band Group 1		STANDARD	PREFERRED	NEW
Flute	Rental Rate:	$17.95	$24.95	$32.95
Plastic Clarinet	Repair:	$8.00	$8.00	$8.00
Trumpet	Tax:	$1.43	$1.81	$2.25
Trombone	Monthly Price:	$27.38	$34.76	$43.20
Snare / Bell / Combo Kit
Band Group 2		STANDARD	PREFERRED	NEW
Oboe	Rental Rate:	$28.95	$39.95	$49.95
Alto Sax	Repair:	$10.00	$10.00	$10.00
Single French Horn	Tax:	$2.14	$2.75	$3.30
3/4 Baritone	Monthly Price:	$41.09	$52.70	$63.25
Band Group 3		STANDARD	PREFERRED	NEW
Bass Clarinet	Rental Rate:	$33.95	$44.95	$49.95
Tenor / Soprano Sax	Repair:	$10.00	$10.00	$10.00
Double French Horn	Tax:	$2.42	$3.02	$3.30
Baritone / Euphonium	Monthly Price:	$46.37	$57.97	$63.25

Orchestra Instrument Pricing

		STANDARD	PREFERRED	NEW
	Rental Rate:	$17.95	$20.95	$31.95
Violin	Repair:	$8.00	$8.00	$8.00
Viola	Tax:	$1.43	$1.59	$2.20
	Monthly Price:	$27.38	$30.54	$42.15
		STANDARD	PREFERRED	NEW
	Rental Rate:	$23.95	$28.95	$39.95
Cello	Repair:	$10.00	$10.00	$10.00
	Tax:	$1.87	$2.14	$2.75
	Monthly Price:	$35.82	$41.09	$52.70
		STANDARD	PREFERRED	NEW
	Rental Rate:	$43.95	$49.95	$62.95
Bass	Repair:	$10.00	$10.00	$10.00
	Tax:	$2.97	$3.30	$4.01
	Monthly Price:	$56.92	$63.25	$76.96

Band Accessories

Yamaha Care Kit $19.99 - Yamaha maintenance kits come with everything you need to properly maintain and care for your band instrument.Band Method Book $9.50 - $12.99 - We'll include your school's required method book with your instrument rentalMusic Stand $19.95 - Basic black collapsible music stand with bagReeds for Clarinet and Alto or Tenor Saxophone - $10.99 - $14.99 (Pack of 3) - We'll include your school's recommended reeds with your instrument rental, or let us know if you have a preferred brand/strength in the notes box belowReeds for Clarinet or Alto Saxophone - $19.99 - $42.99 (Box of 10) - We'll include your school's recommended reeds with your instrument rental, or let us know if you have a preferred brand/strength in the notes box belowReeds for Bass Clarinet and Tenor or Bari Saxophone - $27.99 - $49.99 (Box of 5) - We'll include your school's recommended reeds with your instrument rental, or let us know if you have a preferred brand/strength in the notes belowDouble Reeds for Oboe or Bassoon - $12.99 - $23.99 (each)

Orchestra Accessories

Rosin $4.99Rock stop $9.99Foam shoulder rest $3.99Polishing cloth $5.99Orchestra Method Book $9.50-$12.99 - We'll include your school's required method book with your rentalMusic Stand $19.95

Additional Notes or Accessories Requested:

Let us know if you need anything else with your instrumental rental, or if you have any specific preferences as far as brands, reed strengths, etc.; Brass Bell will contact you to finalize accessories and pricing

Delivery Options*

School DeliveryPick up in store

Parent/Guardian Name*

First NameLast Name

Email*

example@example.com

Primary Phone Number*

Area CodePhone Number

Alternate Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

I understand that I must have a debit or credit card on file for the monthly rental charges and that Brass Bell will contact me at the phone number provided above to finalize my instrument rental and pricing.

Signature*