Online Musical Instrument Rental
Customer E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.
E-Mail:*  
Instrument Rental Details
Monthly Violin Rental:  
  Fee $20.00  
Monthly Cello Rental:  
  Fee $27.00  
Monthly Guitar Rental:  
  Fee $22.00  
Monthly Drum Rental:  
  Fee $75.00  
Grand Total:  
 
Date of Pickup:*  
Pickup Time:*  
Date of Return:*   mm/dd/yyyy
Return Time:*  
Billing Information
First Name:*   Same name as on your card
Middle Initial:  
Last Name:*  
Address Line 1:*   Where your statement is mailed
Address Line 2:   Apt. or Suite No.
City:*  
State:  
Province:  
Country:*  
Zip Code:*  
Phone:  
Credit/Debit Card Information
Card Number:*   No dashes or spaces please
Expiration Month:*   From your card
Expiration Year:*   From your card
Card Brand:*  

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