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STUDENT AND SCHOOL
Student`s Name*

Grade*

School / Building*

RENTER (PARENTS) INFORMATION
First Name*

Middle Initial

Last Name*

Address*

Apartment

City*

State*

Zip Code*

Primary Phone:*


Home Mobile 

Secondary Phone:


Home Mobile 

E-Mail:*

IMPORTANT: Enter a valid e-mail address. Receipts will be sent to this address.
RENTER`S EMPLOYMENT INFORMATION
If Self-Employed, Retired, or Unemployed, please note in employer box and use home address.
Employer*

Employer Address*

Work Phone:*

City*

State*

Zip Code*

CREDIT AND IDENTIFICATION
Social Security No.*

Birthdate*

Drivers License Number*

Issuing State*

REFERENCE
We recommend listing a relative whom currently does not reside with you. DO NOT USE STUDENTS TEACHER/DIRECTOR
Reference Name*

Address*

Phone:*

City*

State*

Zip Code*

INSTRUMENT SELECTION
BACK TO SCHOOL 1/2 PRICE SPECIAL
Receive your FIRST FOUR (4) months rent for HALF PRICE when paid in ADVANCE!

NEARLY NEW, RENTAL RETURN, & ECONOMY INSTRUMENTS ARE SUBJECT TO AVAILABILITY
Select an Instrument
FLUTE
CLARINET
ALTO SAXOPHONE
TRUMPET
TROMBONE
PERCUSSION

Choose a Percussion Style
SNARE DRUM
BELL KIT
COMBO KIT (BELL & SNARE)


Flute
T
Clarinet
T
Alto Saxophone
T
Trumpet
T
Trombone
T
Snare Drum
T
Bell Kit
T
Combo Kit
T
 
The price quoted reflects the total cost of your initial trial period. Once your trial period or promotion has expired a monthly recurring payment based on your instrument rental level will be charged to your payment source on your designated renewal date. Payments will continue until such time as the instrument returned or your accumulated payments equal the purchase value located on your finalized rental agreement.

FLUTE MONTHLY PAYMENT PLANS

$33.00 PER MONTH - NEW
$28.00 PER MONTH - NEARLY NEW
$23.00 PER MONTH - RENTAL RETURN
CLARINET MONTHLY PAYMENT PLANS

$33.00 PER MONTH - NEW
$28.00 PER MONTH - NEARLY NEW
$23.00 PER MONTH - RENTAL RETURN
ALTO SAXOPHONE MONTHLY PAYMENT PLANS

$55.00 PER MONTH - NEW
$50.00 PER MONTH - NEARLY NEW
$45.00 PER MONTH - RENTAL RETURN
TRUMPET MONTHLY PAYMENT PLANS

$33.00 PER MONTH - NEW
$28.00 PER MONTH - NEARLY NEW
$23.00 PER MONTH - RENTAL RETURN
TROMBONE MONTHLY PAYMENT PLANS

$33.00 PER MONTH - NEW
$28.00 PER MONTH - NEARLY NEW
$23.00 PER MONTH - RENTAL RETURN
PERCUSSION MONTHLY PAYMENT PLANS

$28.00 PER MONTH - NEW
$24.00 PER MONTH - NEARLY NEW
$21.00 PER MONTH - RENTAL RETURN
 
MAINTENANCE & REPLACEMENT PLAN (M&R)
M&R Enrollment*
ENROLL (Select plan below)
OPT OUT

``OPT OUT``: If you select the ``OPT OUT`` option you agree to the following statement.
``I do not desire to take advantage of the TBO Maintenance & Replacement Plan.
By doing so I understand that I am fully responsible for all maintenance, loss,
or damage which may occur to the instrument.``
Maintenance & Replacement plan (5 dollars per month)
LESSON BOOK / STARTER PACKAGE
Lesson Book
T
Lesson Book
T
PAYMENT TOTALS
Sub-Total:
Tax (OH 6.75%):
Grand Total:
PAYMENT SOURCE - CREDIT CARD INFORMATION
Card Brand*

Card Number*

Exp Month*

Year*

CVV2*

RENTAL AGREEMENT TERMS & CONDITIONS
***I the renter have read and agree to the stated terms and conditions of this agreement as set forth by Taylor Band & Orchestra. If at any time I am unable or unwilling to make the agreed upon payment I understand that I am obligated to return the instrument to Taylor Band & Orchestra Inc or authorized affiliate. I authorize Taylor Band & Orchestra to charge my MC/VISA/DISC/AE number supplied for all monthly payments until such time that the instrument is returned to Taylor Band & Orchestra or authorized affiliate, or the ``purchase option`` requirements are fulfilled. I understand that this agreement is subject to credit approval and I give my permission for Taylor Band & Orchestra to review my credit history by credit report whenever necessary.***
I have read and accept these therms and conditions.*
 

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