727-822-3460

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Mon - Fri 10:00a - 6:00p | Sat 10:00a - 5p | Sun Closed

INSTRUMENT RENTAL AGREEMENT

All fields are required, if a field is non applicable to you please enter 'na' or

you will recieve an error message when submitting the form.

* Required Field

Instrument Selection

Instrument: *

Alto Saxophone

Baritone/Euphonium

Clarinet-Plastic

Clarinet-Wood

Combo Percussion Kit

Double French Horn

Drum Kit

Flute

Guitar

Percussion Kit

Piccolo

Single French Horn

Tenor Saxophone

Trombone

Trumpet

Cello **

Viola **

Violin **

Oboe

** Sizes Available - 1/4, 1/2, 3/4, 4/4

Size (if applicable): *

Instrument Grade: *

Renter Billing/General Information

We offer three monthly rental rates for each instrument, based on availability and your credit worthiness.
We will explain these to you when we contact you to finalize your rental.

Relationship to Student: *

Full Name: *

Spouse Name: *

Street Address: *

City: *

State: *

Zip Code: *

Do you rent or own your home?: *

How long have you been at your current address?: *

Previous address if at current address for less than a year:

Street Address: *

City: *

State: *

Zip Code: *

Phone

Cell Phone: *

Home Phone: *

Renter Credit/Employment Information

Social Security #: *

Date of Birth (MM/DD/YYYY): *

Drivers license #: *

Employer Name: *

Employer Address: *

Employment Position: *

How long have you been employed at your current job?: *

Work phone (number + extension if applicable): *

Where do you do your banking: *

Nearest relative NOT living with you

Name: *

Relation to you: *

Address: *

City: *

State: *

Zip: *

Phone (With Area Code): *

Alt Phone (With Area Code): *

Spousal Credit / Employment Information

Spouse Social Security #: *

Date of Birth (MM/DD/YYYY): *

Drivers license #: *

Employer Name: *

Employer Address: *

Employment Position: *

How long at this job?: *

Work phone (number + extension if applicable): *

Student Information

Full Name: *

Full School Name: *

Grade: *

Parents Home Email: *

Parents Home Email (Confirm): *

Billing Information

First Name:*

Last Name:*

Address:*

Address2:

City:*

State/Province:*

Zip/Postal Code:*

Payment Information

Card Type: *

Name on Card:*

Card Number:*

Card Expiration: *

CVV Code:*

Agreement

This application may be subject to a credit check: *

Decline

By entering my Social Security Number below, I acknowledge that I have read, understand and accept the terms and conditions of the Instrument Rental Agreement. Entering your Social Security Number also serves as your unique and valid electronic signature which will bind you to the terms and conditions.

Do not submit this application before reading and accepting or declining the terms and conditions above.

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Add:: 2129 First Avenue N.; St. Petersburg, FL33713
Tel:: 727-822-3460