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INSTRUMENT RENTAL ORDER FORM

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INSTRUMENT RENTAL ORDER FORM Powered By Docstoc
					Ardsley Musical Instrument Service, Ltd. 219 Sprain Rd. ~ Scarsdale, NY 10583 ~ U.S.A. Phone (914) 693-6639 ~ Fax (914) 693-6974 www.ardsleymusic.com ~ E-mail rentals@ardsleymusic.com

INSTRUMENT RENTAL ORDER FORM
Please use a separate form for each instrument you order. Fill out all information in each numbered item below. Sign form in ink and mail with check or money order made out to Ardsley Music. Instruments and accessories will be delivered to school. There are no refunds on early returns.

INCOMPLETE ORDERS WILL BE RETURNED TO SENDER.
1. 2. 3. 4. 5. 6. Check one

Renewal

New Request for Rental

7. 8. 9. (Required) (Required)

Home Phone Father's Work Phone Mother's Work Phone

Student's Name School Music Teacher Instrument Circle Size (String Instruments)
(For Office Use) (For Office Use) 1/16 1/10 1/8 1/4 1/2 3/4 4/4

A CREDIT CARD IS REQUIRED FOR SECURITY REGARDLESS OF PAYMENT METHOD.
10. 11. 12. 13.

M/C, VISA, DISC., AMEX # Expiration Date Card Holder's Name Card Holder's Signature
$ . . . . . .

Brand

Serial #

14. 15. 16. 17.

Enter cost of rental on this line---------------------------------------------------------------Enter correct amount for damage protection (required)---------------------------------Enter correct amount for Instrument Replacement Protection - IRP------------------(accessory kits are needed - add 7% sales tax) Enter cost of accessories, books and tax from previous page----------------------------Add for total to enclose with order-----------------------------------------------------------

Enter sales tax on this line - See chart below. (required by law)----------------------------$
$ $ $ $

18.

19.

I agree to assume all responsibility for loss or damage incurred to the instrument rented during the rental period (normal wear excepted). Renter absolves Ardsley Musical Instrument Service from any claims arising from the use of the rented instrument. Damage coverage absolves me from any liability for instrument damage (except broken strings) during normal use. Vandalism and/or attempts at repair void coverage and may incur reasonable repair fees. Optional Instrument Replacement Protection (IRP) agreement covers replacement of legally substantiated (police/fire/school report required) theft of one instrument per rental period from home or school. Claim must be made within 10 business days of occurrence. IRP does not cover acts of negligence, instruments left in parked cars or on transportation and expires with rental. Renter agrees to notify Ardsley Music of intentions to return the instrument through the school. Renter will obtain return authorization, pickup date and pickup location from Ardsley Music and will abide by their return instructions. Renter understands that the school is not involved in this agreement and that IRP becomes void if the instrument is lost as a result of renter’s failure to follow return instructions. Renter understands that if the instrument becomes more than 30 days in arrears the renewal or replacement fee plus an applicable past due fee will be charged to renter’s securing credit card. Renter agrees to pay any collection and/or legal fees. Ardsley Music reserves the right to report past due accounts to one or more credit rating services. This contract is not transferable. Renter agrees to advise Ardsley Music of any change in school, phone number and/or address. Renter understands that Ardsley Music is not responsible for personal items left in cases of returned instruments. 20.

Parent Sign Here

X
Please sign in ink.

21.

Date

PARENT'S NAME AND ADDRESS BELOW
22 23

24 (If P.O. Box, Please Provide Street Address)

Sales Tax Chart - Rent Only Rental Fee 8.50% 8.13% 8.00% $72.50 $6.16 $5.89 $5.80 $76.50 $6.50 $6.22 $6.12 $79.50 $6.76 $6.46 $6.36 $124.95 $10.62 $10.16 $10.00 $164.50 $13.98 $13.37 $13.16

7%
$5.08 $5.36 $5.57 $8.75 $11.52

Thank you for your patronage. Best wishes for a successful musical experience!

Ardsley Musical Instrument Service, Ltd. 219 Sprain Rd. ~ Scarsdale, NY 10583 ~ U.S.A. Phone (914) 693-6639 ~ Fax (914) 693-6974 www.ardsleymusic.com ~ E-mail rentals@ardsleymusic.com

Accessories

To place an accessory and/or book order please circle items below. Include the correct amount with your order and the accessories will be delivered to school with your instrument.

Accessories are necessary for the proper functioning of your instrument. Beginning students need accessory kits (listed below in bold type). They contain all your child will need to use his or her instrument properly. Note that the cost of the kit is lower than the cost of the same accessories purchased individually. Other accessories are also available. Call for prices. Books are listed in the right- hand column. All books delivered will be Volume I unless otherwise indicated. HEALTH ADVISORY: Accessories that are “included” with rentals by other dealers may have been used by previous renters. ONLY USE NEW ACCESSORIES!
ALL INSTRUMENTS CLARINET LESSON BOOKS
BAND METHODS Accent on Achievement....................... 6.95 6.95 Music Stand....................................... - 3 Reeds, Cork Grease, 13.95 KIT Music Stand Carrying Case................... 4.95 Swab, Mouthpiece Brush................. 6.25 Manuscript Note Book................................ (circle size): 1 1/2, 2, 2 1/2, 3 2.39 Reeds

About Musical Instruments......................................... 9.95

Meisel Tuner/Metronome.......................… 29.95 Clarinet Reeds (each)...................................Easy.......................... 1.34 Breeze

Luggage Tag........................... 1.95 Clarinet Reeds (box of 10)..................... Sueta.......................................... 13.28 Ed 6.95

VIOLIN & VIOLA
Video Tape (Violin Primer)........

Thumb Saver.......................……….1.68 Learn To Play.............................7.50 9.99 Reed Holder (holds 4 reeds)............... Drum Method............................... 2.75 9.95

KIT - Rosin, Pitch Pipe....……….. 6.25 Teeth Saver...........................……….. Roy Burns Elementary 2.76 Kun Shoulder Rest (1/16-1/4)........... 21.53

ALTO SAX

Rubank Elementary Method........................................ 5.50 5.95 5.95 Standard of Excellence.........

Kun Shoulder Rest (1/2 - 3/4)..........25.95 - 3 Reeds, Cork Grease, 25.95 KIT Resonan Shoulder Rest............ 9.60 Reeds (circle size): 1 1/2, 2, 2 1/2, 3

Kun Shoulder Rest (4/4)................... Swab, Mouthpiece Brush................. 26.95 7.95 Sounds Spectacular............. Hill (upgrade) Rosin................. 6.96 Alto Sax Reeds (each)........................................ How It Works Series 2.02

Student Violin Rosin....................... Alto Sax Reeds (box of 10)...................... 2.40 20.24 The Violin...................................... 7.95 Case Carrying Strap................ 3.95 Thumb Saver.......................………….. The Flute............................... 7.95 4.60 STRING METHODS All For Strings.............................4.95 Essential Elements 2000 Peg Drops.............................. 6.95 Teeth Saver...........................…….. 2.76 Violin Workbook......................... .95 6 Violin E String.................................... Holder (holds 4 reeds)............... 1.89 Reed 2.75 Violin A String.................................. 4.65

TRUMPET

Violin D String................................... - Valve Oil, Tuning Slide 5.56 KIT

Violin G String..................................... Mouthpiece Brush...................................... 6.05 Lube, 5.25 for Strings.................................... 6.95 Viola A String...................................... Premium Valve Oil....................... 5.22 Al Cass 4.36 Essential Elements Viola D String..................................... 7.35 Trumpet Snake....................………. 4.12 for Strings.................................... 5.50 Viola G String...................................... 8.05

TROMBONE

Learn To Play a Stringed Instrument............................... 5.95 5.95 6.95 15.95 6.95 3.45 13.95 11.95

Viola C String..................................... - Slide Oil, Tuning Slide 9.66 KIT

CELLO

Lube, Mouthpiece Brush.............................. Strings........................ 5.25 Strictly

KIT - Rosin, Pitch Pipe............................... Snake..................………. 4.44 Suzuki Books........................ 6.50 Trombone End Pin Anchor....................................... 12.64 Super Slick Slide Cream........………… 2.00 Suzuki CD's.......................... Peg Drops............................ 6.95 Super Slick Tuning Slide Lube............ 1.56 Theory Is Fun.................... Tourte Mute.......................... 6.00 Cello D String..................................... 13.72 Cello G String................................... 16.80

Rock Stop.......................................... Slick Spray Bottle....…....…....…....…....…....… 5.45 Super 1.80 Suzuki Cassettes........................12.95

DRUM
Drum Sticks Circle Size: (2B, 5A, 5B, 7A)

Muller Rusch String Wohlfahrt Foundation Studies For Violin..........…… 9.60 Studies For Viola...........…….. Total Cost of Accessories Sales Tax - 7% Total

Cello A String..................................... - Sticks & Practice Pad...................... 11.90 KIT 10.95 Method.........................…….

Cello C String.................................... 18.27 Student Drum Sticks........................ Wohlfahrt Foundation 6.95

FLUTE

Vic Firth Sticks (wood tip).....……….

KIT - Swab.................................................. 1.95 Vic Firth Sticks (plastic tip)...................... 9.99 Silver Polishing Cloth............... 6.99 Remo Practice Pad 6"........................ 17.00 Case Cover w/Shoulder Strap... 33.20 Remo Practice Pad 8"........................ 19.40 Remo Practice Pad 10"...................... 24.60


				
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