to fill out our rental agreement form

Marian Weiner 516 747-5107 Ext. 2
E-mail: MARIAN@POPPASMUSIC.COM
Fax 516 294-4289
168 Jericho Tpke.
Mineola N.Y. 11501
Clarinet Flute Piccolo Trombone
Trumpet Cornet Drum Violin Viola
Alto Sax
Jericho Tpke. Between Mineola Blvd. & Willis Ave.
Across from Municipal Parking
ACCESSORIES
PRICE
Cello Viola 15” 16”
NEW
Like New
NEW
Clarinet Mpc. Kit
um1k
$10.00
$50
$50
$100
$100
Alto Sax Mpc. Kit
umak
$13.00
YEAR
$95
10 MONTHS
$80
SUMMER add deposit $25
$138
$120
$35
$175
$150
$35
$245
$210
$45
Trumpet-umtpt & Fr Horn umfh Mpc $12.00
Trombone Mpc
umtb
$16.00
umtk
Tenor Sax Mpc. Kit
$14.00
MONTH
$21
$18
$25
Clarinet Reeds
Bassoon
$225
$850
Bass Clarinet French Horn Bari Horn
Oboe Tenor Sax String Bass Soprano Sax
Bari Sax
Tuba
Alto Sax Reeds
Drum Pad and sticks
Valve Oil-xpvoil Slide OilCork Grease
R1A
xdk6s
xmsoil
xpcgt
$17.75
$25.00
$1.50
$1.35
Like New
Rosin
xkrosv
$3.00
Like New
DEPOSIT
add deposit
$14
Dbl. French Horn
10 MON. Curved head flute $150
Flugelhorn
DEPOSIT
YEAR
10 MONTHS
$190
Like New
NEW
$200
$240
$175
$300
$525
$500
SUMMER add deposit $40
MONTH add deposit $25
$50
$35
$430
$400
SHIPPING (Small)
SHIPPING (Large)
Notes:
R11
$12.55
$25.00
$40.00
$65
Replacement & Repair Coverage Group 1 & 2/$15 Group 3/$25 Group 4/$40 Coverage for rental instruments against repairs from daily
use. In the event of loss, fire, or theft, Poppa’s Music agrees to cover the replacement value of the rented instrument with a documented
police report. Cosmetic damage, neglect & abuse are not covered. Expendable items such as strings, bows, bridges, mouthpieces
accessories & cases are not covered. The waiver does not relieve the renter from any outstanding payments owed to Poppa’s Music.
NAME OF PARENT OR GUARDIAN (first)_________________________(last)_____________________________________
ADDRESS_______________________________________________CITY____________________STATE_____ZIP_______
WORK ADDRESS___________________________________________CITY____________________ST.______ZIP_______
HOME PHONE (____)__________________CELL #(_____)____________________ WORK #(____)____________________
E-MAIL____________________________ DRIVER’S LICENSE_________________________________________________
STUDENT______________________________SCHOOL______________________TEACHER________________________
AGREEMENT: At the end of the rental period, I may re-rent the instrument, or return it within 24 hours. I retain the right to terminate this
agreement at any time by returning the instrument to Poppa’s Music Music Inc.. There will be NO REFUND if the instrument is returned early.
If my address, phone number, or credit card is not current, I will give Poppa’s Music current info within 10 days. I authorize my credit card to
be charged for repairs due to negligence or the replacement value if the instrument is lost or stolen. If the instrument is not returned to Poppa’s Music Inc. within 10 days after the due date, I will be charged on my credit card for the replacement value of the instrument minus the
rental fee, and ownership is transferred to me. If I return the instrument 10 days after the due date, a credit will be issued to my charge minus
a $2 per day late charge. Title & right of possession of instrument remain with the company. I will pay attorney fees if Poppa’s finds it necessary to take court action to repossess their instrument, or to collect past due amounts.
I HAVE READ THIS CONTRACT AND ACCEPT THESE TERMS.
SIGNATURE OF PARENT OR GUARDIAN________________________________________DATE____________
REQUIRED CREDIT CARD #__________________________________________EXPIRATION DATE_________
DATE DUE_________ INSTRUMENT_________________BRAND _____________SERIAL #________________