Your Family Still Matters, 175 W. 900 S. #14, St. George, UT 84770. (435) 628-7042

Instrument Rental Agreement

Steps: 1) Select Instrument | 2) Enter Information | 3) Review Contract | 4) Make Payment

Cello Student Level | Monthly payment: $30.00 | Term: 30 months
If this is correct, please complete and submit the form below. Otherwise start over

An initial payment of $30.00 will be charged to your card today. Monthly payments will begin 2018-11-06 and will automatically be charged to your card.

If you have rented from us before, enter your phone number (xxx-xxx-xxxx). Otherwise just fill in the form.

Phone:   

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Your information

First Name:		Last Name:
Student Name:		School:
Phone: (xxx-xxx-xxxx)		Phone2:
Drivers License:		Address:
City:		State:
Zip:		Email:
Cello Student Level		Select Size 1/2 3/4 4/4	Questions about size? Call us (435-628-7042).
Referred by:		Referring person's phone:

Staff notes:

Model:   Serial No:

Condition: