Coles Music Service Instrument Repair Request Form
Print out this form, place it in the instrument and leave it with your band director at school in the place designated by them for repairs. Our school representative will pick up the instrument on the normally scheduled day.

When you hit submit below, a copy of this form will be sent to our office to alert our representative that a repair is waiting to be picked up at the school.

All estimates will be sent to the email address provided. No work will be performed without approval. Repairs must be paid in full prior to them being returned back to the school.

Email address *
School Name *
Your answer
Enter Make/Brand *
Your answer
Instrument *
Enter Serial # *
Your answer
Describe Problem/Work Requested *
Your answer
Student First Name *
Your answer
Parent's Name *
Your answer
Email Address *
Your answer
Daytime Phone (with Area Code) *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zipcode *
Your answer
A copy of your responses will be emailed to the address you provided.
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