Online Rentals :: Online Rental Form - The Music Center, Inc.

Online Rental Form

The fields marked with * are mandatory

Please complete this form to start your rental application. In order to help protect your privacy and the security of your information, we can not collect all of the information that we need over the internet, someone will contact you shortly for additional required information.

Select Preferred Location:

Student Name:

School Name:

Parent Name:

Mailing Address:

City:

State:

Zip:

Street Address:

City:

State:

Zip:

Telephone (Home):

Telephone (Cell):

Employer:

Employer Phone:

Spouse Employer:

Spouse Employer Phone:

Emergency Contact (Person not residing with you):

Emergency Contact Phone:

Instrument:

Brand:

Pickup / Delivery:

I agree that should my account become delinquent, I grant The Music Center, Inc. permission to collect my student's band or string instrument (as noted on contract) at their school. I understand that the instrument is the property of The Music Center, Inc. until it is paid in full. I also give authority to the band director and school officials to release possession of the instrument to The Music Center, Inc. without any recourse. DELENQUENCY OF 3 PAYMENTS authorizes the use of my credit/debit card to pay off the remaining balance under the terms of the signed Trial Purchase Agreement or Instrument Rental Agreement.

Possession Waiver:

Parent Signature (Sealed):

Parent Drivers License #:

Spouse Signature (Sealed):

Spouse Drivers License #:

Email Address:

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Online Rental Form

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