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Sam`s Strings "Select" Instrument Rental Form
Customer E-Mail
Important: Enter a valid e-mail address. Receipts will be sent to this address.
E-Mail:*
Billing Information
First Name:*
Last Name:*
Middle Initial:
Driver`s License #:*
Address Line 1:*
Address Line 2:
City:*
State:
Zip Code:*
Home or Cell Phone:*
Employer*
Work Phone:*
Students Name*
School*
Credit Card Expiration Month*January
Credit Card Expiration Year*2008
What instrument do you want to rent?
Availability is on a first come - first serve basis, but we will do our best to accomodate your requests!
Instrument Type*
Violin
Viola
Cello
Bass
Subject to availability!
"Select" Violin Rental*
3 months initial rental and maintenance fees (plus sales tax)
"Select" Viola Rental (14inch and smaller)
3 months initial rental and maintenance fees (plus sales tax)
"Select" Viola Rental (15inch and larger)
3 months initial rental and maintenance fees (plus sales tax)
"Select" Cello Rental*
3 months initial rental and maintenance fees (plus sales tax)
"Select" Bass Rental*
3 months initial rental and maintenance fees (plus sales tax)
What Size Instrument Do You Need?*1/4, 1/2, 3/4, etc
Serial Number (if known)
Do you need a Shoulder Rest (viola 14inch and smaller, please select violin shoulder rest)
Do you need a shoulder rest?*
Yes
No
Subject to availability!
Foam Shoulder Rest
Foam Sponge Shoulde Rest (plus sales tax)
Violin Shoulder Rest
Basic Shoulder Rest (plus sales tax)
Violin Shoulder Rest (KUN)
KUN brand Shoulder Rest (plus sales tax)
Violin Shoulder Rest (Everest)
Everest brand Shoulder Rest (plus sales tax)
Viola Shoulder Rest
Basic Shoulder Rest 15" or Larger (plus sales tax)
Viola Shoulder Rest (KUN)
KUN brand Shoulder Rest (plus sales tax)
Viola Shoulder Rest (Everest)
Everest brand Shoulder Rest (plus sales tax)
Do you need a rockstop (Cello and Bass only)? ie. Slipstop, Xeros, etc
Do you need a rockstop?*
Yes
No
Subject to availability!
Rockstop
Slipstop rockstop (plus sales tax)
Rockstop
Xeros rockstop (plus sales tax)
Do you need a metronome/tuner?
Do you need a metronome/tuner?*
Yes
No
Subject to availability!
Metronome/Tuner combo
Intelli-204 (plus sales tax)
Metronome/Tuner combo
Korg TM-50 (plus sales tax) BACKORDERED TIL 10/1/22
TM-60 and CM-300Mic
Korg TM-60 and CM-300 Tuning Pickup (plus sales tax) BACKORDERED TIL 10/1/22
NS Micro Violin Tuner
NS Micro Violin Tuner (plus sales tax)
NS Micro Universal Tuner
NS Micro Universal (works for bass/cello) Tuner (plus sales tax)
Do you need a music stand?
Music Stand
Hamilton Folding Music Stand (plus sales tax)
Do you need books?
Do you need any books?*
Yes
No
Subject to availability!
Essential Elements 1
Essential Elements Book 1 (plus sales tax)
Essential Elements 2
Essential Elements Book 2 (plus sales tax)
Essential Elements 3
Essential Technique (plus sales tax)
Suzuki Book 1
Suzuki Book 1 (without CD) (plus sales tax)
Suzuki Book 1 (with CD)
Suzuki Book 1 (with CD) (plus sales tax)
Sound Innovations
Sound Innovations for String Orchestra (plus sales tax)
Progressive Rep
Progressive Repertoire for Bass (plus sales tax)
Notespeller
Notespeller for Violin/Viola/Cello/Bass (plus sales tax)
Master Theory Book 1
Master Theory Book 1 (plus sales tax)
Orchestra Expressions 1
Orchestra Expressions Book 1 (plus sales tax)
Do you need anything else?
Other itemsie. mute, spare strings
When do you need your instrument by?
Date instrument needed by*8/17/22
Total
Grand Total (before sales tax)
After the initial 3 month rental period, you will be charged on a monthly basis:

Sam`s Strings Select Rental Pricing
Violin and Viola (14inch and smaller) = $29.99 ($24 Rental + $5.99 Maintenance) + tax
Viola (15inch and larger) = $32.99 ($25 Rental + $7.49 Maintenance) + tax
Cello = $51.99 ($43 Rental + $8.99 Maintenance) + tax
Bass = $61.99 ($52 Rental + $9.99 Maintenance) + tax
Fee Structure and Payment Policy
Rental fees must be paid in advance monthly, and will be automatically deducted from your credit card on file. Rental contracts are Month to Month, with the first 3 months fees being paid at the opening of a rental agreement. This initial 3-month payment is non-refundable, after which the contract continues month to month, until the instrument is returned. Return/Past Due Account Policy 1) Returns: Returns can be made at anytime! To avoid being charged for the following month, instruments must be returned by the last day of the preceding month. In addition, the first 3 months rent are non-refundable, regardless of if you return the instrument beforehand. 2) Past Due Account Policy: You may rent the instrument for as long a period as you wish, so long as your monthly rental payment is on time and in full.. If you are having trouble making a payment, please contact us, we will try and work out a solution with you. However, if we do not hear from you, and payments are more than 30 days late, a $10 penalty fee will apply. Clients with rental contracts over 60 days delinquent must return our instruments, or we will report the instrument stolen. We reserve the right to use any remedy deemed necessary (including lawsuit) to take possession of unreturned rental instruments and to collect all past due rental fees, late fees, and legal fees, collection costs, and losses due to instruments not covered by the maintenance agreement. Possession of an instrument owned by us constitutes acceptance of the terms of this contract.

Pre-ordering a Rental: Upfront payment of the first three month’s rent is accepted in good faith, and the contract begins on the day the instrument is picked up or delivered to the renter. We know that life throws curve balls and plans change! This charge is refundable up until the date the instrument’s contract is set to begin (ie, the first day of school).

Maintenance Protection Plan Details
The renter will be responsible for our instrument, including theft or damage (reasonable wear excepted), until the instrument is returned. The renter is required to pay for a monthly maintenance agreement. The maintenance agreement covers broken bridges and bows, and general upkeep of the instrument. Major damage to the body of the instrument, including but not limited to broken necks, and stolen instruments may result in a $150 deductible fee for violin, $350 for cello, and $400 for bass. Claims for stolen instruments must include a police report. The maintenance agreement is not in effect during air or overseas travel, except with specific authorization. The maintenance agreement will not cover: Theft from an automobile, heat damage, lost or intentionally damaged instruments; damage incurred during shipping; or shipping costs. We must perform or authorize all repairs. We reserve the right to charge the cost of repair or replacement to any credit card on file, should damage or loss not be covered by the maintenance agreement. Renters whose instruments are stolen or badly damaged will lose any equity accrued. Should maintenance or repair be required on an instrument, bow, and/or case, the renter is responsible to bring the instrument, bow, and/or case to Sam`s Strings during regular business hours. Sam`s Strings may also be able to provide other pickup and delivery options as an added convenience.

Monthly Maintenance Fees: Violin $5.99 / Viola $7.49 / Cello $8.99 / Bass: $9.99 
Rental Credit
This is not a “rent to own” contract. The instrument being rented is NOT for sale. However, if the renter wishes to purchase any of our many instruments for sale, we offer the following: 100% of your rental fees can be applied up to half the list price of any instrument we have in stock (violin starting from $649, violas from $799, cellos from $2299 )- ie: 2 years of violin rentals at $21 X 24= $504; Purchase a violin at $899, and $449.50 can be applied to the purchase). Equity is not transferable to other instruments or accessories (ie. cello to violin). The maintenance and tax payments are not included. Instrument equity may not be combined with other rentals’ equity. Equity expires when the instrument is returned. *Renters whose instruments are stolen or badly damaged will lose any equity accrued up to the purchase price of the instrument.
Terms and Conditions
By E-Signing, I understand and agree to the terms, conditions, definitions, rates, and costs as explained on the Sam`s Strings Rental Form and agree to have my credit card charged for the amount selected above.

E-Signature*
Last 4 Digits of the Credit Card to be Charged* XXXX
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