Online Rental Contract
12 Week Trial Period
13th, 14th, 15th & 16th week free rental.

Please select an Instrumental Group
based on the type of instrument you are interested in.
 
ON-LINE REGISTRATION REQUIRES CREDIT OR DEBIT CARD ONLY
 
Instrumental Group # 1
Flute Trombone
Clarinet Drum Kit
Trumpet Percussion Kit
Violin Violin Size:
   
$38.00
Please Select Instrument. Monthly Rental fee after trial period will be $37.00 a month, except for violin which is $27.50 (see purchase option).
   
Instrumental Group # 2
Oboe
Alto Sax
Viola

Viola Size:
   
$75.00
Please Select Instrument. Monthly Rental fee after trial period will be $49.00 a month, except for viola which is $37.00 (see purchase option).
   
Instrumental Group # 3
Tenor Sax
French Horn
Baritone Horn
Cello

Cello Size:
   
$88.00
Please Select Instrument. Monthly Rental fee after trial period will be $55.00 a month, except for cello which is $45.00 (see purchase option).
   
Security Agreement:
You are giving a security interest in the instrument and in the accessories included in the contract.
   
Fields with * = required
   
STUDENT
*First Name:
*Last Name:
*School District:


Music Instructor:
   
Lessee # 1 (Parent or Guardian)
*Please Select One:
*First Name:
*Last Name:
*Address:
*City:
*State:
*Zip Code:
Work Phone:
*Home Phone:
*E-Mail Address:
*Social Security#:
   
Lessee # 2 (Spouse)
First Name:
Last Name:
Address:
City:
State:
Zip Code:
Work Phone:
Home Phone:
E-Mail Address:
Social Security#:
   
*Nearest Living Relative not living with you:
*First Name:
*Last Name:
*Full Address:
*Phone #:
 
Cliff Girard Music will supply the teacher recommended music book (prices range from $5.95 to $9.95 and $14.95 for percussion)
Add a Music Book to my order
   
An instrument cleaning kit for band instruments or cleaning cloth for stringed instrument is recommended for keeping your instruments in top condition.
Add a cleaning kit/cloth to my order. $16.00
   
A music stand is recommended for all students. It is essential that students learn the correct posture required to play an instrument.
Add a music stand to my order. $12.00
   
Woodwind Instruments (sax $9.00 and clarinet $ 7.00) include one reed with rental, but additional reeds are recommended for your first lesson.
Add a 5-pack of reeds to my order.
   
Please Read Return Policy below.
 
You are NOT being charged at this time. You WILL receive notice before we charge your credit/debit card.
   
*Credit Card Type:
*Credit Card /
Debit Card #:
*Expiration Date: Month: Year:
If your card has a 3 or 4 digit security code (usually printed on the signature strip on the back of the card) enter it below:
*3 or 4 Digit Code
 
By hitting submit you are electronically signing a legal contract & acknowledge that you have read and agreed to the terms of contract. You also agree that we may do a credit check and that the information you entered is accurate.