Instrument Rental Request Form

Instrument: Pre-owned Crescendo violin outfit - $14.00/month New Crescendo violin outfit - $19.00/month Pre-owned Crescendo viola outfit - $15.00/month New Crescendo viola outfit - $22.00/month Pre-owned Crescendo cello outfit - $34.00/month, $45.00/month 4/4 size New Crescendo cello outfit - $60.00/month

Size: 4/4 3/4 1/2 1/4 1/8 1/16 (violin only) 16.5 in. (viola) 16 in. (viola) 15.5 in. (viola) 15 in. (viola) 14 in. (viola)

Maintenance Fee: Yes protect my instrument No thank you

Optional maintenance fees are available at $3.00 per month for violin and viola, $5.00 per month for cello.
Maintenance fees cover all damage due to wear and tear, cracks, and other repairs at trade-in or return, such as new strings, new bridge, and instrument cleaning and polishing.
Additionally, refundable security deposits equal to 3 months rent will be added to the initial billing period:
New Rental:           Violin - $57.00     Viola - $66.00     Cello - $132.00
Pre-owned Rental: Violin - $42.00     Viola - $45.00     Cello - $102.00 or $132.00 for 4/4 size
Shipping charges will also be added to the initial billing period:
Violin/Viola - $22.00     Cello - $65.00

Please provide the following ordering information:

BILLING - submitted via secure server

Credit Card: Visa MasterCard

Cardholder name:

Card number:

CVV Number:

Expiration date:

SHIPPING

Street address:

Address (cont.)

City:

State/Province:

Zip/Postal code:

Country:

Please provide the following additional contact information:

Employer:

E-mail:

Phone Number:

Comments or special instructions?

I have read and agree to abide by the terms outlined in the rental agreement NOTE: - Box must be checked in order to complete application