Premium Rental Application
Please fill out the following for Instrumental Music Company. IMC will contact applicant for additional information.
Parent/Responsible Party's First Name *
Your answer
Parent/Responsible Party's Last Name *
Your answer
Student's Name: *
Your answer
School *
Your answer
Teacher's Name *
Your answer
Home Address *
Your answer
City/State/Zip Code *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Instrument *
These are Monthly Prices. Your credit card will only be charged monthly. All maintenance is included with this price.
Name (First, Last) *
By typing your name here you agree to the above terms and conditions.
Your answer
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