Hauer Music Rental Form
Instrument
*
Flute
Clarinet
Trumpet
Cornet
Trombone
Alto Sax
Oboe
Tenor Sax
French Horn
Baritone/Euphonium
Drum Kit
Bell Kit
Drum and Bell Kit
Violin
Viola
Cello
Condition
New
Demo
Used
Parent's Last Name
*
First Name
*
Middle Initial
Email
*
Address
*
City
*
State
*
Zip
*
Social Security #
*
Home Phone #
*
Employer
*
Employer Address
Occupation
Employer Phone
Driver's License #
*
Spouse Name
Spouse Employer
Spouse Employer Phone
Nearest relative not residing with you
Relative's relationship
Relative's Phone
Child resides with
Mom
Dad
Both
Student's Name
*
School Attended
*
Grade
*
Hauer Rep
Bill Hauer
Bill McIntosh
Ray Marion
Pat Swank
Barb Tucker
Mark Zink
Don't Know
Enter Code
*
MAINTENANCE AND REPAIR POLICY The maintenance coverage is included in the monthly fees of your instrument lease plan. Under the maintenance policy lessor will; make adjustment to the instrument at no charge; repair or replace any part damaged due to accidental breakage; repair or replace any malfunction or maladjustment of any worn, loose, or improperly fitted parts. The maintenance option does not include mouthpieces, mouthpiece caps, ligatures, reeds, lyres, swabs or any accessories. This maintenance option does not cover loss resulting from ill usage, abuse or neglect. Lessee agrees that NO REPAIR SHOP OTHER THAN LESSOR MAY WORK ON THE ABOVE INSTRUMENT WITHOUT THE WRITTEN PERMISSION OF LESSOR. Lessor and lessee agree that the maintenance option will become void and of no effect if the rental account becomes past due.
