Step 2

Lessee Name*

First NameLast Name

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState

Zip Code

Cell Phone Number*

Nearest Relative Phone #*

Social Security Number*

This will be hidden on PDF Form

Employer Name*

Employer Phone*

Drivers License #*

DL Expiration*

Date

DL State Issued*

Date of Birth*

Date

Student Name*

First NameLast Name

Student's School*

Current Grade*

AutoPay
An Andy's Music representative will contact you by phone to establish a monthly rental Autopay. We accept all major credit and debit cards. Autopay must be in the Lessee's name.

TOTAL COST OF INSTRUMENT****

Monthly Payments to Own (42)

Monthly Payment (Including Tax)

Peace of Mind Service Plan

Total Cost of Instrument including Tax and POM Service Plan

Monthly Payment (Including Tax) PDF only

Instrument Rental Price - POM (PDF Only)

Subtotal - (PDF Only)

Mississippi State Tax

Alabama State Tax

Total Cost of Instrument + Tax (PDF Only)

Monthly Payment - PDF Only

Each subsequent payment will be automatically debited from the AutoPay on the monthly anniversary date of the rental unless the instrument is returned.

How would you like to obtain the rental instrument?*

Pick up at Andy's Music. Open 6 days a week.Ship to my home. (Certain restrictions apply)Deliver to school (Certain restrictions apply)Other

Step 3

Signature*

Today's Date

Date

Today's Date (Top)

Date

Any questions or comments?

Social Security PDF Only

Product Description

Cash Price

Model #

Allegro Step-Up Rental Application

Allegro Rental Application

Step 2

Step 3