Band Instrument Rental Application Step 1 of 5 - 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? 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Yes No Mobile PhoneApplicant Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Applicant Social Security Number* Employer* 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 agree to the rental application Authorization Agreement viewable above. I Agree Will you be using a co-applicant?* Yes No Co-Applicant Full Name* Is the address, email, and primary phone number the same as the primary applicant?* Yes No Email Address* Enter Email Confirm Email Co-Applicant Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Phone Number*Co-applicant Secondary Phone NumberCo-Applicant Date of Birth*MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Co-Applicant Social Security Number* Employer* Employer Phone Number* Authorization AgreementDo you (Co-applicant) agree to the terms of the Authorization Agreement?*By clicking I Agree, you agree to the rental application Authorization Agreement viewable above. I Agree Instrument*FluteClarinetAlto SaxTenor SaxTrumpetTromboneFrench HornBaritonePercussionViolinViolaCelloInstrument*FluteClarinetAlto SaxTenor SaxTrumpetTromboneFrench HornBaritonePercussionStandard 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. SOE Flute $10.50SOE Clarinet $10.50SOE Alto Sax $10.50SOE Tenor Sax $10.50SOE Trumpet $10.50SOE Trombone $10.50SOE French Horn $11.50SOE Baritone $10.50SOE Percussion $11.50, + Alfred Beginning Drum Method $9.99Already 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. Flute $9.99Clarinet $9.99Alto Sax $9.99Tenor Sax $9.99Trumpet $9.99Trombone $9.99French Horn $9.99Baritone $9.99Percussion $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 $16.99 (You Save $1.15)Better Value Pack $29.99 (You Save $5.14)Best Value Pack $39.99 (You Save $8.13)I already have accessories $0.00Recommended Flute Accessory Packages*Flute accessory packs and their regular prices 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 $19.99Better Value Pack $35.99Best Value Pack $49.99I 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 PackBetter Value PackBest Value PackI already have accessories $0.00Recommended Tenor Sax Accessory Packages*Tenor Sax accessory packs and their regular prices 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 $16.99 (You Save $1.15)Better Value Pack $29.99 (You Save $5.14)Best Value Pack $42.99 (You Save $12.64)I already have accessories $0.00Recommended Trumpet Accessory Packages*Trumpet accessory packs and their regular prices are as follows: Value Package: (Mouthpiece Cleaner and Care Kit) Best Value Package: (Value Pack + Music Stand) Value PackBest Value PackI already have accessories $0.00Recommended Trombone Accessory Packages*Trombone accessory packs and their regular prices are as follows: Value Package: (Mouthpiece Cleaner and Care Kit) Best Value Package: (Value Pack and Music Stand) Value PackBest Value PackI already have accessories $0.00Recommended French Horn Accessory Packages*French Horn accessory packs and their regular prices are as follows: Value Package $22.85: (Mouthpiece Cleaner $3.99 and Care Kit $18.86) Best Value Package $39.84: (Value Pack $22.85 and Music Stand $16.99) Value Pack $20.99 (You Save $1.15)Best Value Pack $32.99 (You Save $6.85)I already have accessories $0.00Recommended Baritone Accessory Packages*Baritone accessory packs and their regular prices are as follows: Value Package $22.85: (Mouthpiece Cleaner $3.99 and Care Kit $18.86) Best Value Package $37.97: (Value Pack $20.98 and Music Stand $16.99) Value Pack $19.99 (You Save $.99)Best Value Pack $32.99 (You Save $4.98)I already have accessories $0.00Recommended Percussion Accessories*Stick Grip TapeMusic StandGrip Tape and Music StandI already have theseRecommended Violin/Viola Accessories*Music Stand $16.99Violin/Viola Care Kit $18.86Music Stand + Care Kit $34.99I 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 $9.4910-Pack $20.75I 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 $36.90I already have reedsTotal $0.00 Credit Card Type*VisaMastercardDiscoverCredit Card Number* Expiration Date (Month/Year)* 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 FREEDelivery Notesexample: "For Fall Delivery" or "Summer Program" *please note, Summer Program delivery may not be available, we will notify you if the instrument must be picked up from us.*Total(6% PA sales tax will be added on to the total and payment will be processed after the application is approved) $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.