This is a secure form and your information is held in strictest confidence. We do not sell or distribute any of this information.

Our rental program offers the following features:

Rent month-to-month.
100% of the rental fee goes towards purchase.
No Interest....EVER!
No Obligation to continue renting or purchase.
Maintenance/Replacement (M&R) protection available.
Loaner Instruments available for M&R customers.
Flexible exchange and purchase options.
Only top brand name instruments rented and sold.
Complete accessory, music, and repair departments.
Loaner music stand available.
Road service to remote areas in which we rent.
EXPERIENCE....serving Colorado school programs since 1951.

STEP ONE (Choose Instrument)		* Please Note - This contract is subject to credit approval.
$23 per month	Flute	The instrument you will be renting will either be a previously played instrument or a new instrument depending on availability. Did you know? Our Previously Played instruments are all professionally cleaned and repaired by our in store service department.
$23 per month	Clarinet
$23 per month	Trumpet
$23 per month	Trombone
$23 per month	Violin - * Size (select one)
$23 per month	Viola - * Size (select one)
$23 per month	Percussion Kit (bells, practice pad, bell stand, sticks, mallets, and bag.)
$23 per month	Combo Kit (bells, snare drum, bell and snare stand, sticks, mallets, and bag.)
$23 per month	Snare Drum Kit (snare drum, snare stand, sticks and bag.)
$30 per month	Piccolo
$40 per month	Alto Saxophone
$40 per month	Oboe	Instruments such as oboes, piccolos or baritones are available in limited quantities. A Flesher-Hinton Music Co. representative will contact you if your instrument is unavailable.
$40 per month	Cello - * Size
$54 per month	Bass Clarinet
$54 per month	Tenor Saxophone
$54 per month	Baritone
$54 per month	French Horn

STEP TWO	Choose Accessories
$4 per month	Maintenance and Replacement Plan (M&R) A smart investment! Accidents do happen, and for only $4 a month you can relax, knowing your child's instrument will be taken care of. Our Service Protection Plan includes: * Complete coverage of all necessary repairs and maintenance, due to normal wear and tear, to keep your child's instrument sounding great! * FREE loaner instruments while your child's instrument is being repaired. * FREE pickup and delivery at most schools within our service area. * Replacement of instruments stolen or damaged beyond repair. * The M&R provision is OPTIONAL. By not choosing this provision, the renter accepts full responsibility for all maintenance and any loss of, or damage to, this property. When choosing this option, FHMC agrees to: ALL REPAIRS MUST BE DONE BY FHMC to be covered. Damage caused by intent, neglect, or abuse is not covered. REPLACEMENT: FHMC will replace the instrument with one of the same type and of equal value in case of loss by fire or theft. NO OTHER LOSS IS COVERED. Theft must be reported to the police and FHMC within 72 hours. M&R is not intended to replace, or act as insurance. M&R VOID ON DELINQUENT ACCOUNTS
Free during rental period. $14 value	MUSIC STAND (An important tool for at home practicing!) We provide a music stand with your rental. The stand is on loan to you for the duration of the rental. The only time you should have to pay for the stand is if you do not return the stand if you happen to return your rental instrument. When the instrument is purchased, the renter may return or purchase the stand for the price noted, plus tax.
Music Book	Essential Elements 2000 Book 1 Includes CD/DVD	Standard of Excellence - Book 1 $6.95	Essential Elements 2000 for Strings Includes CD/DVD	All for Strings - Book 1 $5.50

STEP THREE	Tell us about your child and his/her school.
Student's First Name
Student's Last Name
Student's Grade
School District
School Name
Music Director's Name

STEP FOUR	Personal Information/Billing Information This info will be used to process a credit application.
Applicant (Parent / Guardian) Name: (Required)
Address: (Required)
Mailing Address: (if different)
City COLORADO Zip Code: (8XXXX) (Required)

Buying or Renting Residence How long at current residence?
Home phone: Work phone: (Both Required)
Employer: How long have you been employed there?

Applicants Drivers License #: Example: XX-XXX-XXXX (Required)
Your E-Mail Address: (Required)
Spouse:
Spouse's Employer:
Spouse Work Phone:
Nearest Relative NOT Living With You:
Relative's Phone:

Are you coming into our store to pick-up the instrument? Choose one only. Coming into Store. Our Road-Rep to deliver (If we are to deliver the instrument an email will be sent explaining when and where the rep will leave the instrument. In some cases the rep will leave the instrument at the schools front office or with the music instructor.)
LAST STEP (Payment and terms and conditions)
Visa MC Disc AmEx
Credit Card #: Exp. Date: This is a one time charge for the first months rent and accessories selected. Your card will not be charged again or held on file with FHMC. You will receive quarterly statements which you can use to pay by check through the mail or you may call 303-433-8891 to make a credit card payment over the phone. Tax will be added and a total will be e-mailed to you as soon as contract is processed. Card number not needed for rental exchange
REQUIRED! By typing "yes" in this box, you agree to Flesher-Hinton Music Co's terms and conditions and that you are a legal resident of Colorado, 21 years of age or older. (please print terms and conditions and keep for your records)
IMPORTANT PLEASE READ! By pressing the "Submit" button, you authorize Flesher-Hinton Music to investigate your credit in relation to the rental of the instrument indicated. You will be notified by a Flesher-Hinton Music Co. representative of your approval via phone call or email. Also, a grand total including tax will be sent to you via email and the credit card you provided will be charged. You will also receive an email explaining where and when the instrument will be delivered. This is a legal and binding contract. Please keep all emails and contract information for your records. Thank you for choosing Flesher-Hinton Music Co. for your musical needs. Please allow 3 business days to process your application.

This is a secure form and your information is held in strictest confidence. We do not sell or distribute any of this information.
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Thank you

-fhmc