MUSIC HOUSE - WALK-IN CUSTOMER
SUBMISSION FORM
Rental Instrument
:
CLARINET <AlmostNew>
Before you fill out this form you should have given the customer a RENTAL CONTRACT. Only after the customer has filled out a rental contract should this form be submitted. Fill out the information in this form from the RENTAL CONTRACT.
per/mo
checks are not accepted <cc only>
Base Rent
25
Use Tax
2.00
add
Theft & Damage Coverage ?
TOTAL
$
6.00
per/mo
yes
no
< Print BLANK Rental CONTRACT >
<
CLICK - IF THE INSTRUMENT BELOW IS CORRECT?
CLARINET <AlmostNew>
<
ENTER INST SERIAL #
Renters 1st Name:
< fill the information out with information provided by customer < from a rental contract you should have provided the customer
Last Name:
May I have your HOME ADDRESS:
Su DOMICILIO:
May I have the CITY YOU LIVE IN:
y la CUIDAD:
*PO BOX NOT ACCEPTED
and the STATE
. . . (y el estado)
ZIP >
(y el codigo postal
and your EMAIL:
Ph #:
(
)
How did you find out about Quick Rents?
List of Music Stores from School District
Music House Flyer
Phone Book Yellow Pages
Display in Laguna Hillls Mall
Heard from a Friend
Rented Before
OTHER
Credit/Debit Card Information
Accepted Cards
Choose CREDIT/DEBIT card type
Credit Card
Debit Card
( Required for 1st Month Payment )
Card #
Expiration:
mo
yr - ex:09 03
Cardholder Name:
check
if same as above
>
first
last
Acct will be Autobilled unless checked for "Mail-In Payments "
< Prefers to Mail-In Pymts
. . .
AUTOBILL
. Credit Card/Debit Card>
location:
MH CORPORATE STORE & REPAIR
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
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25
26
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31
2024
2025
Pickup TIME
8:00am
8:30am
9:00am
9:30am
10:00am
10:30am
11:00am
11:30am
12:00noon
12:30pm
1:00pm
1:30pm
2:00pm
2:30pm
3:00pm
3:30pm
4:00pm
4:30pm
5:00pm
5:30pm
6:00pm
6:30pm
7:00pm
7:30pm
8:00pm
8:30pm
9:00pm
Todays Date:
XXX