Form

Parents Full Name:*

E-mail:*

Phone:*

Work Phone*

Address:*

City:*

State:*

Zip code:*

Instrument Requested*

School District*

Student Full Name*

School Attending*

Delivery Selection*

If an instructional method is indicated by your school, please list it here

We use Passwords and School Codes to assist us in monitoring the requirements of individual schools and districts. If you received a Password or School Code, please enter it here- your account will reflect the requirements of your district at the time of shipment or pickup. Don't have a password or school Code? No problem, it is not required to rent from us, our customer service staff will assist you in receiving what your district requires.

All School or Promo Codes (if any)

If you do not want to provide the following information you may reserve your instrument on the following page: reserve an instrument

Ths form is secure. If we are shipping an instrument, you will need to provide the following information to process your rental. If you are picking up at the store, providing this information will speed your check out. If you do not want to provide this information, you may reserve your

Credit Card Number*

Credit Card Expiration MMYY*

Drivers License Number*

Drivers License State*

I plan to pickup my instrument

Please acknowledge at you have reviewed and agree to the rental agreement by making your selection in the following box. You will be provided a competed copy of the agreement when the instrument is picked up, or in some cases prior to shipping.

I have read the rental agreement and agree to it.*

I agree

Thank you, we will confirm your reservation no later than the following business day.