Instrument Rental Form

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What instrument do you need? Violin Viola Cello Flute Clarinet Trumpet Trombone Alto Sax

What instrument size do you need? Unknown 4/4 Full Size 3/4 1/2 1/4 1/8 1/10 1/16 What instrument size do you need? Unknown 16 inch 15.5 inch 15 inch 14 inch 13 inch 12 inch 11 inch

What lesson books do you need? None Essential Elements Level 1 ($8.99) Essential Elements Level 2 ($8.09) Essential Elements Level 3 ($8.09) Strictly Strings ($6.99) Suzuki Level 1 ($8.09) Suzuki Level 2 ($8.09) Suzuki Level 3 ($8.09) Traditions of Excellence Level 1 ($9.95) Traditions of Excellence Level 2 ($9.95) Standards of Excellence Level 1 ($9.50) Standards of Excellence Level 2 ($9.50)

What accessories do you need?
 Folding Music Stand - $19.95
 Rock Stop - $8.50 (optional for cellos)

Regular Monthly Rental Rates
(per-month rate; three-month minimum required; sales tax not included)

VIOLIN $20  •  VIOLA $25  •  CELLO $40
FLUTE $25  •  CLARINET $25  •  TRUMPET $25  •  TROMBONE $25
ALTO SAXOPHONE $45

We highly recommend our optional maintenance program, particularly when instruments are traveling between home, school, private lessons, and get-togethers. Show in-depth maintenance program specifics.

The renter will be responsible for our instrument, including theft or damage, until the instrument is returned. Our maintenance program covers repair/replacement of your instrument due to normal wear and use, accidental damage, or theft. This includes the replacement of parts and labor. It does not cover accessories or supplies. Our maintenance program does not cover theft or temperature damage to the instrument if it was left inside a vehicle, a lost or an intentionally damaged instrument, damage incurred during shipping, or shipping costs. A claim for a stolen instrument must include a police report. When the rental expires, the maintenance program expires. If the renter does not purchase our maintenance program, and an instrument is damaged or stolen, we reserve the right to charge the cost of repair or replacement to the renter’s credit card on file. Our shop must perform or authorize all repairs.
(hide maintenance program)

Maintenance Program Rates

• $5.00 per month - violin, viola, flute, clarinet, trumpet, trombone
• $6.00 per month - alto saxophone
• $10.00 per month - cello

Would you like to add the optional maintenance program?
 Yes
 No

How would you like to receive reminders for future rental payments?
 Automatically charge my credit/debit card every 3 months
 Email (be sure email field above is completed)
 USPS Mail

How would you like to acquire your instrument?
 Deliver to my child's school (Pella customers only)  Please ship instrument to me at the above address. (shipping available only outside of the Des Moines metro area)

Your instrument will be reserved for one week. After a week, you may complete a new online reservation form or complete a rental contract at the time of instrument pick-up. If the instrument will be picked up by someone other than the responsible party, please call us at (515)274-9420 with your valid credit/debit card number and the name of the person who will be picking up the instrument.

Shipping cost is a minimum of $15 and will be added to the initial rental payment. Cellos cannot be shipped.

Requests/Comments/Questions?

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