Music Center Rental Form

	To apply for your musical instrument, please complete the application below. FOR YOUR PROTECTION, YOU ARE NOT REQUIRED TO PROVIDE SENSITIVE INFORMATION (SUCH AS SS# AND CREDIT CARD INFORMATION) IF YOU ARE SUBMITTING THIS FORM ONLINE. UPON OUR RECEIPT OF YOUR ONLINE APPLICATION, A MUSIC CENTER REPRESENTATIVE WILL CONTACT YOU BY TELEPHONE TO OBTAIN THIS INFORMATION FROM YOU FOR PROCESSING PURPOSES.

	*** Please Ensure all FIELDS and APPROPRIATE CHECK BOXES are filled out BEFORE SUBMITTING your form. We thank you for your consideration.

	Click here to Review the Terms and Conditions before proceeding

	---> Click Here If you prefer a print out copy

Montgomery Country Music Center, Inc.

=======================================================================================================================================================================================

Acceptance of Agreement Subject to Credit Approval

Renter (First, Middle, Last)

Spouse (First, Middle, Last)

Physical Street Address

Mailing Address (if Different)

Please Initial Here:

Click Here to Deduct Payment from this card each month? =>

SHOULD YOU NOT HAVE A MAJOR CREDIT CARD, COMPANY REQUIRES 2 LOCAL REFERENCES

Credit Reference Name

Nearest Relative (Name & Address)

Orchestra Instruments receive automatic exchange privilege for upsizing purposes as long as the value (cash replacement price) remains the same (i.e. U1 for a U1). Full size instruments will require a new contract agreement.

By clicking the box below, I have read and I understand and agree to the terms, conditions, and definitions explained within this agreement .

Monthly Rental Rate:	\|	$
Maintenance:	\|	$
** Loss Damage Waiver (optional) :	\|	$
Sales Tax:	\|	$
Total Monthly Payment:	\|	$

Music Book (fill out below)	\|	$
	\|	$
	\|	$
	\|	$
	\|	$
Accessories Sub Total:	\|	$
Accessories Sales Tax:	\|	$
Accessories Total :	\|	$

Total Amount Due:	\|	$

Montgomery County Music Center, Inc. agrees to rent the undersigned customer the following instrument at the rate determine; a 4 month minimum rental period is required.

Instrument		Brand
Serial #:		Prem.MPC
Cash Replacement Price*	$

I have read and I understand and agree to the terms, conditions, definitions, rates, costs, and prices as explained within this agreement. I also understand my next payment will be due on (mm/dd/yyyy) and my number of payments will be to acquire ownership.


By clicking the box I understand that this application/agreement is duly signed by the renter that is identified above. It also gives the Music Center the authority to process my application. Please click to the box to agree on the conditions ------------------------------->

PLEASE PRINT OUT A COPY OF YOUR AGREEMENT AND THE TERMS
AND CONDITIONS FOR YOUR PERMANENT RECORDS AT COMPLETION.

*Signature of Renter	TDL#

*Signature of Renter	TDL#


Accepted for Montgomery County Music Center, Inc.	Date (mm/dd/yyyy)


	If you have any comments you wish too leave, please leave them here (100 characters please):


	By clicking SUBMIT, you authorize the Music Center to deduct the total amount due from the credit card provided and on file with the Music Center. Thank you for allowing the Music Center to be involved in your investment of your child's musical education .