Instrument Rental Agreement
Instrument to be rented
*
violin - $26.75 with tax
viola - $32.10 with tax
cello - $42.80with tax
bass - $85.60 with tax
step up violin - $53.50 with tax
step up viola - $64.20 with tax
step up cello - $85.60 with tax
Instrument Size
*
4/4
3/4
1/2
1/4
1/8
1/10
1/16
1/32
11" viola
12" viola
13" viola
14" viola
15" viola
15.5" viola
16" viola
16.5" viola
need to be sized
*
Delinquent accounts will be sent to collections or court after 60 days.
Signature
*
First Name
Last Name
*
Name of Player
Relationship to renter
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone Number
-
Area Code
Phone Number
Cell Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
Employer
*
Employer's Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Private Music Teacher
School Music Teacher
Personal Reference
This is a friend or family member who lives at a different address than you and would know if you are traveling, or ill, etc. We will only contact them if we are unable to reach you and your account is more than 30 days past due.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
My Products
*
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next
( X )
Violin Rental
(
$
26.75
for each
month
)
Monthly Viola Rental
(
$
32.10
for each
month
)
Monthly Cello Rental
(
$
42.80
for each
month
)
Monthly Violin Rental, Step up
(
$
53.50
for each
month
)
Monthly Viola Rental, Step Up
(
$
64.20
for each
month
)
Monthly Cello Rental, Step Up
(
$
85.60
for each
month
)
Monthly Bass Rental
(
$
85.60
for each
month
)
Subtotal
$
0.00
Tax
$
0.00
Credit Card
Instrument description and value (for office use only)
Submit
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