Instrument Rental Form

Complete this form if you are looking to rent one of the following instruments:
• String Bass
• European Accordion
Please ensure you have fully read our Instrument Rental Terms and Conditions before continuing.
Please note prices are inclusive of 6.625% tax.
First Time Only:
4 months N.A / 10 months $346.53
Monthly Re-rental:
$80.16
Monthly Service Charge:
$9.00
Instruments are covered for normal wear & tear. Instruments will be replaced in case of theft or fire for a one time fee. The cost of this insurance is included in the monthly payment listed above. Please see terms and conditions for additional information and limitations under *Insurance Information*.
No refunds for early returns. After initial return you have the following options:
1. Continue to re-rent the instrument on a continuous monthly basis accumulating money towards the rent-to-own price.
2. Purchase the instrument in one payment at any time and receive a discount.
3. Return the instrument at any time (See Terms and Conditions.)

Complete the Form Below

Step One: Choose Your Instrument

Please confirm your choice of instrument

Please confirm your rental term

Step Two: Customer Information

Name of Lessee

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Lessee #SNN or Date of Birth

To receive an instrument Lessee Social Security# or Date of Birth is required

Lessee / Employer

Lessee's Phone Number

Student Name

Grade

School

Step Three: Credit Card or Deposit Required for Rental

Name on Card

Card Type

Card Number

Expiry Date

Security Code

Automatic Monthly Re-rental Payments (Autopay)

Please check if you would like your monthly payments charged to the above card

Yes

Step Four: Agreement

Please do not complete this form before you have read through and are in agreement with the terms and conditions.

Terms and Conditions

I confirm I have read and agree with the terms and conditions of this rental arrangement

Yes