Instrument Rental Request Form Renter InformationRenter/Parent Name* First Last Billing Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Can we text this number?* Yes No Email Address* Player InformationPlayer/Student Name (if different) First Last Requested Lease Start* MM slash DD slash YYYY Teacher Name* School for Music Lessons* Instrument InformationInstrument*ViolinViolaCelloViolin Rental Level* Standard (monthly: $18 + $3 insurance) Advanced (monthly: $28 + $7 insurance) Master (monthly: $41 + $8 insurance) Viola Rental Level* Standard 11" - 14" (monthly: $18 + $3 insurance) Standard 15" - 16" (monthly: $20 + $3 insurance) Advanced (monthly: $35 + $7 insurance) Master (monthly: $52 + $8 insurance) Cello Rental Level* Advanced (monthly: $37 + $8 insurance) Master (monthly: $68 + $10 insurance) Violin Rental Size* 1/16 1/10 1/8 1/4 1/2 3/4 4/4 (full) Unsure Violin Rental Size* 1/4 1/2 3/4 4/4 (full) Unsure Viola Rental Size* 11" 12" 13" 14" Unsure Viola Rental Size* 15" 15-1/2" 16" 16-1/2" Unsure Viola Rental Size* 13" 14" 15" 15-1/2" 16" 16-1/2" Unsure Viola Rental Size* 15" 15-1/2" 16" 16-1/2" Unsure Cello Rental Size* 1/16 1/10 1/8 1/4 1/2 3/4 4/4 (full) Unsure Cello Rental Size* 1/2 3/4 4/4 (full) Unsure Delivery Method*In-store pickupContactless curbside pickupUPS deliveryAdditional InformationWood Bow Upgrade?* Yes (+$10/month) No Wood Bow Upgrade?* Yes (+$15/month) No How did you hear about us? Teacher/school Online search Word of mouth Comments or QuestionsFor instrument rentals, Sullivan Violins requires a credit card AND either a debit card, checking account, or second credit card. One will be your primary payment method, while the second form of payment will be used as a backup in case of an inability to collect from the primary payment method. Cash is not accepted for rental charges. Please note: This is NOT a rent-to-own program. Up to 12 months of rental equity can be used toward purchase. See Rental Terms and Conditions for more information. By submitting this form, you agree to Sullivan Violins' Rental Terms and Conditions.* I agree CAPTCHACommentsThis field is for validation purposes and should be left unchanged.
