Band Instrument Rental Application Step 1 of 4 - Student Information 0% Student Name* Student Grade* Student School*BlairsvilleBrockwayBrookvilleCameron CountyClarionClarion LimestoneClearfieldCurwensvilleDuboisEast and West ForestElk County CatholicFranklinHarmonyHomer CenterIndianaJohnsonburgKeystoneMoshannon ValleyMarion CenterNorth ClarionNorthern CambriaOil CityPenns ManorPhilipsburgPurchase LinePunxsutawneyRedbankRocky GroveSt. BernardsSt FrancisSt. JosephsSt MarysUnionUnitedWest BranchSchool Building* Don't see your school listed? We are constantly looking at ways to expand and grow our business so contact us and we'll see what we can do about adding your school to the list of serviceable schools! Contact Us Have you rented a band instrument from us before? Yes No Applicant Full Name* Email Address* Enter Email Confirm Email Applicant Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Is "Home Phone" a Mobile Phone? Yes No Mobile PhoneApplicant Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Applicant Social Security Number* Employment Status*EmployedUnemployedEmployer* Employer Phone Number*Closest Relative Not Living With You (Full Name)* Closest Relative Phone #*Relation Authorization AgreementDo you (Primary Applicant) agree to the terms of the Authorization Agreement?*By clicking I Agree, you are acknowledging that you are the applicant for the rental instrument, and that you have read and agree to the rental application Authorization Agreement which is viewable above. I Agree Instrument*FluteClarinetAlto SaxTenor SaxTrumpetTromboneFrench HornBaritonePercussionViolinViolaCelloInstrument*FluteClarinetAlto SaxTenor SaxTrumpetTromboneFrench HornBaritonePercussionPlease note: Due to increased demand and industry supply issues, we are in short supply of percussion, trombones, and clarinets and may be out-of-stock. Rental applications will not be processed until an instrument becomes available. You will be notified via email of the status of your application following submission. -Thank you. Violin Size*1/23/44/4Not SureStandard of Excellence Method Book*This is the method book required for lessons at your school. Flute $10.50Clarinet $10.50Alto Sax $10.50Tenor Sax $10.50Trumpet $10.50Trombone $10.50French Horn $11.50Baritone $10.50Percussion $11.50Already have one $0.00St. Marys Standard of Excellence Method Book*This is the method book required for lessons at your school. Do It! Method for Band Instruments - $8.95Do It! Method for Percussion - $11.00Already have one $0.00Ed Sueta Premiere Performance Method Book*This is the method book required for lessons at your school. Flute $9.95Clarinet $9.95Alto Sax $9.95Tenor Sax $9.95Trumpet $9.95Trombone $9.95French Horn $10.95Baritone $9.95Percussion $10.45Already have one $0.00Punxsutawney Method Book*This is the method book required for lessons at your school. Flute (Essential Elements for Band $12.99)Clarinet (Essential Elements for Band $12.99)Alto Sax (Essential Elements for Band $12.99)Tenor Sax (Essential Elements for Band $12.99)Trumpet (Essential Elements for Band $12.99)Trombone (Essential Elements for Band $12.99)French Horn (Essential Elements for Band $12.99)(Essential Elements for Band $12.99)Percussion (A Fresh Approach to Snare Drum $16.95)Already have one $0.00Tradition of Excellence Method Book*This is the method book required for lessons at your school. Flute $10.95Clarinet $10.95Alto Sax $10.95Tenor Sax $10.95Trumpet $10.95Trombone $10.95French Horn $11.50Baritone $10.95Percussion $13.50Already have one $0.00Sound Innovations Method Book*This is the method book required for lessons at your school. Sound Innovations Flute $9.99Sound Innovations Clarinet $9.99Sound Innovations Alto Sax $9.99Sound Innovations Tenor Sax $9.99Sound Innovations Trumpet $9.99Sound Innovations Trombone $9.99Sound Innovations French Horn $9.99Sound Innovations Baritone $9.99Sound Innovations Percussion $14.99Already have one $0.00Measures of Success Method Book*This is the method book required for lessons at your school. Flute $8.95Clarinet $8.95Alto Sax $8.95Tenor Sax $8.95Trumpet $8.95Trombone $8.95French Horn $8.95Baritone $8.95Percussion $16.95Already have one $0.00Brockway Method Book*This is the method book required for lessons at your school. Flute (Standard of Excellence) $10.50Clarinet (Standard of Excellence) $10.50Alto Sax (Standard of Excellence) $10.50Tenor Sax (Standard of Excellence) $10.50Trumpet (Standard of Excellence) $10.50Trombone (Standard of Excellence) $10.50French Horn (Standard of Excellence) $11.50Baritone (Standard of Excellence) $10.50Performing PercussionistAlready have one $0.00Essential Elements Method Book*This is the method book required for lessons at your school. Flute $12.99Clarinet $12.99Alto Sax $12.99Tenor Sax $12.99Trumpet $12.99Trombone $12.99French Horn$12.99Baritone $12.99Percussion $17.99Already have one $0.00Making Music Matter*This is the method book required for lessons at your school. Flute (Making Music Matter) $12.95Clarinet (Making Music Matter) $12.95Alto Sax (Making Music Matter) $12.95Tenor Sax (Making Music Matter) $12.95Trumpet (Making Music Matter) $12.95Trombone (Making Music Matter) $12.95French Horn (Making Music Matter) $12.95Baritone (Making Music Matter) $12.95Percussion (Making Music Matter) $17.95Already have one $0.00Cranberry Method Book*This is the method book required for lessons at your school. Flute (Accent on Achievement) $8.99Clarinet (Accent on Achievement) $8.99Alto Sax (Accent on Achievement) $8.99Tenor Sax (Accent on Achievement) $8.99Trumpet (Accent on Achievement) $8.99Trombone (Accent on Achievement) $8.99French Horn (Accent on Achievement) $8.99Baritone (Accent on Achievement) $8.99Percussion (Accent on Achievement) $10.95Violin (All for Strings) $5.50Already have one $0.00Elk County Catholic Method Book*This is the method book required for lessons at your school. Flute (Essential Elements 2000) $12.99Clarinet (Essential Elements 2000) $12.99Alto Sax (Essential Elements 2000) $12.99Tenor Sax (Essential Elements 2000) $12.99Trumpet (Essential Elements 2000) $12.99Trombone(Essential Elements 2000) $12.99French Horn (Essential Elements 2000) $12.99Baritone(Essential Elements 2000) $12.99Percussion (Alfred Drum Method) $10.95Already have one $0.00Indiana Method Book*This is the method book required for lessons at your school. Flute (Habits of a Successful Beginning Band)Clarinet (Habits of a Successful Beginning Band)Alto Sax (Habits of a Successful Beginning Band)Tenor Sax (Habits of a Successful Beginning Band)Trumpet (Habits of a Successful Beginning Band)Trombone (Habits of a Successful Beginning Band)French Horn (Habits of a Successful Beginning Band)Baritone (Habits of a Successful Beginning Band)Percussion (Fresh Approach to Snare Drum $16.95 + Fresh Approach to Mallet Percussion $14.95) $31.90Violin (Sound Innovations) $9.99Viola (Sound Innovations) $9.99Cello (Sound Innovations) $9.99Already have one $0.00Penns Manor Method Book*This is the method book required for lessons at your school. Flute (Sound Innovations $9.99)Clarinet (Sound Innovations $9.99)Alto Sax (Sound Innovations $9.99)Tenor Sax (Sound Innovations $9.99)Trumpet (Sound Innovations $9.99)Trombone (Sound Innovations $9.99)French Horn (Sound Innovations $9.99)Baritone (Sound Innovations $9.99)Percussion (Sound Innovations Combined Percussion $14.99)Already have one $0.00Recommended Clarinet Accessory Packages*Clarinet accessory packs - Value Package: (Mouthpiece Cleaner and Care Kit Better Value Package: (Value Pack + Music Stand) Best Value Package: (Better Value Pack + Pad Saver)Value Pack $19.14Better Value Pack $39.13 *most popularBest Value Pack $58.12I already have accessories $0.00Recommended Flute Accessory Packages*Flute accessory packs are as follows: Value pack includes Mouthpiece Cleaner and Instrument Care Kit. Better Value Package: Value pack + Folding music stand. Best Value Package: Better Value Pack + Pad SaverValue Pack $19.14Better Value Pack 39.13 *most popularBest Value Pack $58.12I already have accessories $0.00Recommended Alto Sax Accessory Packages*Alto Sax accessory packs are as follows: Value Package: (Mouthpiece Cleaner and Care Kit) Better Value Package: (Value Pack and Music Stand) Best Value Package: (Better Value Pack and Pad Saver)Value Pack - $19.14Better Value Pack - $39.13 *most popularBest Value Pack - $60.62I already have accessories $0.00Recommended Tenor Sax Accessory Packages*Tenor Sax accessory packs are as follows: Value Package: (Mouthpiece Cleaner and Care Kit) Better Value Package: (Value Pack + Music Stand) Best Value Package: (Better Value Pack + Pad Saver)Great Value Pack - $19.14Better Value Pack - $39.13 *most popularBest Value Pack - $64.12I already have accessories $0.00Recommended Trumpet Accessory Packages*Trumpet accessory packs are as follows: Value Package: (Mouthpiece Cleaner and Care Kit) Best Value Package: (Value Pack + Music Stand) Value Pack - $19.14Best Value Pack - $39.13 *most popularI already have accessories $0.00Recommended Trombone Accessory Packages*Trombone accessory packs are as follows: Value Package: (Mouthpiece Cleaner and Care Kit) Best Value Package: (Value Pack and Music Stand) Value Pack - $19.14Best Value Pack - $39.13 *most popularI already have accessories $0.00Recommended French Horn Accessory Packages*French Horn accessory packs are as follows: Value Package: (Mouthpiece Cleaner and Care Kit) Best Value Package: (Value Pack and Music Stand) Value Pack - $22.98Best Value Pack - $42.97 *most popularI already have accessories $0.00Recommended Baritone Accessory Packages*Baritone accessory packs are as follows: Value Package $22.85: (Mouthpiece Cleaner and Care Kit) Best Value Package: (Value Pack and Music Stand) Value Pack $19.14Best Value Pack $39.13 *most popularI already have accessories $0.00Recommended Percussion Accessories*Stick Grip Tape - $9.99Music Stand - $19.99Grip Tape and Music Stand - $31.78I already have theseRecommended Violin/Viola Accessories*Music Stand - $19.99Violin/Viola Care Kit - $19.99Music Stand + Care Kit - $39.98 *most popularI already have theseClarinet Reeds*For Clarinet, Alto Sax, and Tenor Sax, reeds are needed for the instrument to play. Our rental instruments include 1 reed. Beginners go through reeds quickly and we recommend starting with at least a 3 pack. 3-Pack - $8.9910-Pack - $19.99I already have reedsAlto Sax Reeds*For Clarinet, Alto Sax, and Tenor Sax, reeds are needed for the instrument to play. Our rental instruments include 1 reed. Beginners go through reeds quickly and we recommend starting with at least a 3 pack. 3-Pack - $9.9910-Pack - $29.99I already have reedsTenor Sax Reeds*For Clarinet, Alto Sax, and Tenor Sax, reeds are needed for the instrument to play. Our rental instruments include 1 reed. Beginners go through reeds quickly and we recommend starting with at least a 3 pack. 3-Pack - $12.9910-Pack - $34.99I already have reedsTotal*includes 6% PA sales tax $0.00 Credit Card Type*VisaMastercardDiscoverCredit Card Number* Expiration Date**Please make sure the expiration date is correct MM-YYYY example - "05-2055" Billing Zip Code* 3 Digit CVV Code on Back of Card* Monthly Auto Pay Pay Agreement*Monthly Automatic Payments are required for our band instrument rental program. I Accept Delivery Options*Deliver it to my school for FREEDeliver it to the Dubois Store where I can pick it up for FREENotesexample: "For Fall Delivery" or "Summer Program" *also note sizing for stringed instruments if known *please note, Summer Program delivery may not be available, we will notify you if the instrument must be picked up from us.*ONE TIME OFFER: Save 10% on a portable, collapsible, MUSIC STAND!*As a way to say thank you for starting your child's musical journey, here's an offer for a collapsible music stands that gives you a reliable stand to practice with at home or away from home. Music Stand - $17.99 (regularly $19.99!)No thanks.Upgrade to a 10 pack of clarinet reeds and save!*A 3 pack of reeds is great and will get the student going, but here's a special deal to upgrade to a box of 10 to get you further along their journey without needing to re-order.10 Pack of Reeds Upgrade - (3 pack price: $8.99, add 7 reeds for $10 more! ($18.99)No thanks.Upgrade to a 10 pack of alto sax reeds and save!*A 3 pack of reeds is great and will get the student going, but here's a special deal to upgrade to a box of 10 to get you further along their journey without needing to re-order.10 Pack of Reeds Upgrade - (3 pack price: $9.99, add 7 reeds for $13.99 more! ($23.99)No thanks.Total*includes 6% pa sales tax $0.00 By submitting this application, you agree to the terms of the Band Instrument Rental Purchase Agreement that can be read here: Terms and Conditions.