Instrument Rental Contract
West Michigan Band Instruments
Your Name
Instrument Selection
Select your instrument
Flute
Clarinet
Trumpet
Trombone
Percussion
Alto Sax
Oboe
French Horn
Bass Clarinet
Baritone/Euphonium
Tenor Sax
Violin
Viola
Cello
Upright Bass
Select your instrument
Size (stringed instruments only)
Please select
1/2 Size
3/4 Size
4/4 Size
13"
14"
15"
16"
Please select
Student Information
Student's Name
School
School District
Parent Information
Parent's Name
Email address
Secondary Email
Phone number
Secondary Phone number
Home Address
Date of Birth
Must be in the format mm/dd/yyy
Employer
Payment Information
Card Type
Visa, MasterCard, Amex, etc.
Card Number
4242424242424242
Expiration
MM/YY
Security Code
123(4)
Billing Address
Leave blank if same as Home Address
Terms of Service
I agree to the
terms of service
.
Signature
Clear
Replace this with a title or description
Verification
SUBMIT FORM
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