Band Instrument Rental Form

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Band Instrument Rental Form

Fill out this secure form to begin the rental process for your new band instrument. After you submit the form, a representative will contact you for further steps. All information is transmitted securely, and your information will not be used for any purpose other than your instrument rental.

Rent from September to June and get July and August FREE

Select Instrument Sept-Dec
*First Time Trial*
(Jan. to June)
Flute $40.00 $19.00
Clarinet $40.00 $19.00
Trumpet $40.00 $19.00
Trombone $40.00 $19.00
Saxophone $85.00 $29.00
Tenor Saxophone TBD TBD
French Horn TBD TBD

All Prices Include Limited Insurance


Select Item
Reeds (Enter number of reeds: )
Silver & Laquer Polishing Cloths
Trumpet Valve Oil
Cork Grease
Music Stand
Trombone Slide Oil

Renter's Information

Name of Parent:  
First Name*:
Last Name*:
Permanent Address*:
Home Phone*:
Cell Phone:
Email Address*:
Student's First Name*:
Student's Last Name*:
Student's School:
Name of Instructor (School):
Payment Method

Charge total in 1 payment

Charge in 3 payments made in Sept, Jan, and April

Please provide credit card information below

Card Type



Name on Card
Card Number
Expiration Date
Security Code on back of card
Please type your name here, which will serve as your electronic signature.

Items with asterisks * are required.

Press Submit to send your order information to Your credit card will NOT be charged at this time. A representative will contact you soon to review your contract, review the final pricing, and arrange for quick and convenient delivery of your instrument.


1. PAYMENT IN ADVANCE: Full rental and re-rental credit card payments shall be made in advance. Each rental period after the initial trial period is 3 months. Please note that NO REFUNDS will be given should the instrument be returned prior to the end of each payment period, unless another agreement is made.

2. PAYMENT OPTIONS/PERIODS: All charges are made in 3 payment periods; in the last week of September, first week of January, and the first week of April. All returns must be received before the charge date of the new payment period. Returns made after payment period WILL NOT be refunded. There is a minimum of 3 month rental.

3. If the customer chooses to pay for 10 months (September through June), Rental Instrument, LLC. will add two free months excluding insurance charge (July and August) giving the customer 12 months for the price of 10.

4. RENT TO OWN OPTION: The flute, clarinet, trumpet, trombone, saxophone, tenor saxophone, and French horn qualify for the RENT THREE YEARS – KEEP FOR LIFE program. The renter reserves the right to purchase the instrument out right at any time of rental.

5. The title to the instrument is solely owned by Rental Instrument, LLC. The customer will not loan, sell, transfer, assign, or encumber our interest in this rental agreement and this rented instrument.

6. RENTAL INSTRUMENT LLC. reserves the right to decline or terminate a rental contract.

7. RENTAL INSTRUMENT LLC. OFFERS LIMTED INSURANCE COVERAGE FOR BAND INSTRUMENTS. This insurance coverage is offered subject to the following:

A. Rental Instrument, LLC. will provide free maintenance and adjustments from normal wear and tear of the instrument. Any damage to the instrument can only be repaired by Rental Instrument, LLC. Damage of the instrument is covered under this insurance up to the retail replacement value of the instrument, after which the instrument will be considered a "total loss". If available, Rental Instrument, LLC. will provide a loaner instrument for the duration of the repair at no extra cost.

B. Any damage or breakage of the instrument will be repaired to the playing condition at no charge. HOWEVER, insurance will NOT cover damage or loss caused by the mishandling, abuse or neglect of the instrument. Rental Instrument, LLC. will determine whether damage is due to mishandling, abuse or neglect of the instrument.

C. Rental Instrument, LLC. reserves the right to decline further insurance coverage. Additional insurance can be purchased.

D. Loss through theft, total destruction by fire or accident, will result in the replacement of the Instrument by an Instrument of equal value, based on the quality, age and condition of the instrument, as determined by Rental Instrument, LLC. Theft or fire must be reported to the proper authorities within 24 hours, and a police report must be presented to Rental Instrument, LLC. The customer is still liable for rental payments up to the reporting to Rental Instrument, LLC. of said loss.

E. Claims for repair or replacement will NOT Change the customer's obligations under the rental or rent-to-own agreement.

F. Rental Instrument, LLC. reserves the right to refuse rental or repair due to excessive damage or negligence.

8. Rental Instrument, LLC. is not obliged to remind the customer of due dates for rental payments.

9. At the end of any rental contract, the instrument must either be re-rented, purchased or returned with the original contract. Twenty days after the rental expiration date, Rental Instrument, LLC. will convert the rental contract to a purchase which will automatically charge to the customer's credit card. Rentals returned 1 to 20 days late will be assessed with a $2.00 per day late charge to the customer's credit card.

10. The customer agrees to renew the credit card used in this transaction for the length of this contract period and any extensions or renewals.

11. If the bank declines any payment, or if the instrument has not been re-rented, purchased or returned within 20 days of the due date, the customer becomes liable immediately for the total balance due on the instrument, including all reasonable costs for collection of bad accounts, including but not limited to attorney costs, court costs, collection/repossession costs, and damage to the instrument. In any legal action, exclusive venue will lie in the jurisdiction of Fairfield County, Connecticut.

12. At the beginning of each rental period or purchase, pictures of the instrument, both front and back, will be taken and kept on file by Rental Instrument, LLC. to assist in determining the condition of the instrument at the time of rental or purchase UNLESS the instrument is in new condition.

13. Any shipping costs related to the rental or purchase of the instrument are the customer’s responsibility, and the customer shall secure shipping insurance up to the full retail cost of the instrument.

By my electronic signature, I, the customer, confirm that I have read, fully understand, and agree to all terms and conditions contained in this contract.

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