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 *
Enter Make/Brand *
Instrument *
Enter Serial # *
Describe Problem/Work Requested *
Student First Name *
Parent's Name *
Email Address *
Daytime Phone (with Area Code) *
Street Address *
City *
State *
Zipcode *
A copy of your responses will be emailed to the address you provided.
Submit
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This form was created inside of Coles Music Service.