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?*YesNoEmail Address*Player InformationPlayer/Student Name (if different) First Last Requested Lease Start* Date Format: 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*1/321/161/101/81/41/23/44/4 (full)UnsureViola Rental Size*11"12"13"14"UnsureViola Rental Size*15"15-1/2"16"16-1/2"UnsureViola Rental Size*11"12"13"14"15"15-1/2"16"16-1/2"UnsureViola Rental Size*11"12"13"14"15"15-1/2"16"16-1/2"UnsureCello Rental Size*1/101/81/41/23/44/4 (full)UnsureDelivery Method*In-store pickupContactless curbside pickupUPS deliveryAdditional InformationWood Bow Upgrade?*Yes (+$10/month)NoWood Bow Upgrade?*Yes (+$15/month)NoAdd Bundle?*Deluxe Bundle: $74.99 ($94.95 value): Includes Everest shoulder rest, method book of your choice, Magic Rosin, polish cloth, music folder, music stand, music bagBasic Bundle: $19.99 ($25.99 value): Includes sponge, method book of your choice, polish cloth, music folderNo bundleAdd Bundle?*Deluxe Bundle: $74.99 ($95.99 value): Includes Xeros, method book of your choice, polish cloth, music folder, music stand, Magic Rosin, music bagBasic Bundle: $27.99 ($33.99 value): Includes Xeros, method book of your choice, polish cloth, music folderNo bundleHow did you hear about us?Teacher/schoolOnline searchWord of mouthComments 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 CAPTCHANameThis field is for validation purposes and should be left unchanged.
