*Parent or Guardian (Lessee):

*Date of Birth:

*Address:

*City:

*Zip Code:

*Drivers License Number:

*Home Phone Number:

Work Phone Number:

Cell Phone Number:

Email Address:

Have you rented with us before?
Yes No

*Students Name:

*School:

Teacher

*City:

*Grade:

You are not obligated to rent until
you sign a physical contract.

- Minimum commitment is three months.
After three months, contracts are on a month to month basis.

- Purchase the instrument at any time!
Receive 35% off of you balance in the first year or 30% at any time after.

- Full Insurance is included in your monthly payment.
Insurance covers loss, damage, and theft.

- McCourts Music will deliver your instrument to your school

*Nearest relative not living with you:

*Relationship:

*Address:

*City:

*Phone: