rental

* * PLEASE NOTE: We only rent Pianos or V-Drums within ~45 mile radius of Austin, TX * *

Your First & Last Name: *

Cell Phone: *

Email: *

Physical Address: *

Unit Number (if applicable)

City: *

State *

Zip: *

Home Phone (if actually used):

Employer:

Work Phone:

Spouse Name:

Spouse Cell Phone:

Spouse Employer:

Spouse Work Phone:

Nearest Relative Name/Phone: *

Have you spoken to one of our staff about a rental yet? *

How did you hear about us? *

Type of Rental *

Short Term Rental (daily, weekly, or monthly, no minimum)

Rent-to-Purchase (lower monthly rate, 4 month minimum, includes option to purchase)

Please indicate the model you want to rent: *

Notes? *

Student Name and Age: *

Teacher Name and Phone: *

Lesson Method/Books: *

Credit Card:

A $5 processing fee will be charged right away. The other fees will be charged once we contact you to discuss the details and delivery time has been scheduled.

Name on Card *

Credit Card Type *

Credit Card Number *

Expiration Date (mm/yy) *

Driver's License: *

DL State *

Date of Birth * +