1420 SE 163rd. Ave.
Vancouver, WA 98683
360.694.7134 • 800.729.7134
www.beacockmusic.com
Date: Check here if you have rented from us before
Student’s Name: Grade: School:

Your Name: Address:

City: State: Zip: Phone: Social Security:

E-Mail: Cell Phone: Drivers License:

Residence Type: Own Rent Board Landlord Name & Phone:

Time at Residence: Years Months

Your Employer: Phone:
How Long? Years Months

Spouse’s Name: Spouse Employer:
Phone: How Long?
Relative or Friend Not Living With You: Phone:
Credit Reference: Debit Visa MC Amex Disc
Card Number: Expires:
To Rent an Instrument
1. Select your instrument preference.
All instruments are guaranteed School Approved Instruments and are in excellent working condition. Economy, Good, and Premium instruments have been leased before, processed by our repair technicians, sterilized, and retail rates reduced accordingly. New instruments have never been leased or sold before and involve a higher total investment.
2. Make your choice of the optional Repair & Replace (R & R*) coverage. (Complete details listed in Terms & Disclosures)
Yes, I request the R & R* coverage at a cost of $ per month for each instrument.
No, I decline the R & R* coverage and will be financially responsible for all damage or loss
and will maintain the instrument in its original condition and playability at my own expense.

Payment Method
Automatic Debit to Checking Account (Attach Check & Authorization Form)
Automatic Credit Card Billing or Debit Card Billing (If different from above)
Card Number:
Expires:
Terms & Disclosures
Initial Period: is one (1) month (minimum) following receipt of your first month rental payment (plus tax) and delivery of the instrument.
Rental Term: This rental term shall be from month to month and shall be automatically renewable each month. You will receive use of the instrument for successive one (1) month terms so long as monthly payments are made on or before due date and you comply fully with all agreements and conditions herein. Rental fees are not refundable and only apply to the instrument selected according to the terms of the agreement.
Purchase Option: This option shall apply to the purchase of an instrument of the same, or of greater quality, as the instrument rented under this agreement. This option shall apply only to instruments within the instrument lines carried by Beacock Music Co. at the time the purchase option is exercised. Should customer exercise this option to purchase, the amount owed shall be the published list price less rental payments made for the first 12 months of the contract, 6 months for percussion/snare kits, or 3 months for guitars months of the contract. Customer agrees that only payments made during the above number of months shall be credited to the purchase price and payments made after this period will not be applied toward the purchase price of
the new instrument. Title and right of possession remains with Beacock Music Co. during the rental term. You have no right to sell, mortgage, pawn, pledge, encumber, or dispose of said property.
Exchanges: During the rental term, you may exchange the instrument listed on this agreement for any other band or orchestra instrument, providing that your account is current. If you receive an instrument in a different rental
price category, the new rate takes effect as the date of the exchange.
Loss, Damage & Maintenance: You (customer) are responsible for maintaining and servicing the instrument. You are also responsible for loss and all damage (in excess of normal wear and tear) and destruction of property. Optional coverage is available to protect against all losses by initialing the Yes line in item #2 above.
Termination By Customer: (YOU) You may, at your option, terminate this agreement by returning the instrument to Beacock Music Co. in the same condition as the time of the rental, fair wear and tear excepted, and by payment of all rent payments and other charges due through the date of the return. Rental fees will accumulate until property is received at Beacock Music Co. Music teachers and other third parties shall not be responsible for the return of the property. Rental fees paid cover the period of time you had the instrument, whether instrument is actually used or not, are non-refundable and have no value toward the purchase of any other product sold by Beacock Music Co. Termination By Owner: Beacock Music Co. may, without notice, terminate this agreement upon the failure of the customer (YOU) to make rental payments required or by breach of any other condition of this agreement. You shall immediately return the instrument to Beacock Music Co. and pay any unpaid rental payments and other charges due to date of return and any damage charges, fair wear and tear excepted.
Delinquency Charges: Rental payments received 10 days or more after the due date will be charged a $5.00 late fee. If your account is delinquent and you fail to return the instrument, we reserve the right to charge a pickup service fee and/or attorneys’ fees to send an agent or go to an outside collection firm to your house to collect our instrument.
Right of Reinstatement: A customer who fails to make timely payments has the right to reinstate the original rental agreement without losing any rights or options previously acquired under the rental agreement within (3) months after the last lease term for which the customer made a timely payment provided the customer surrenders the rental property to the owner or its agent requests him to surrender the rented property. Before reinstating, the customer is required to pay any unpaid rental payments, delinquency and late charges. Oral Statement and Performance: It is understood that no other agreement, guarantee, warranty, verbal or written, expressed or Implied shall limit or qualify the terms of this agreement.
Other: It is the customers responsibility to notify us of any concerns or problems with the instrument or your account so that we can resolve them. Beacock Music Co. must be notified at once of any change of address, phone number and or/the school your child is attending. Repair & Replace (R & R*), Damage, & Maintenance Coverage (Optional): The R & R coverage is optional and must be selected by the customer by initialing the Yes line in item #2 above and paying an additional monthly fee. Loss coverage includes all adjustments and repairs, accidental damage and loss by fire or theft, with no deductible, subject to the following terms:
1 The deterioration of appearance (scratches, minor dents, finish) is not covered insofar as it does not affect the playing of the instrument.
2 Accessories (reeds, straps, sticks, rosin, mouthpieces, etc.) are not covered.
3 Any instrument totally destroyed by fire or accidental damage, or lost by theft will be replaced with an instrument of equal value at no charge, provided reasonable proof of such loss is presented and the theft is reported to the local police within 24 hours of discovery of the theft.
4 All adjustments and repairs must be made by Beacock Music Co. Do not attempt any repairs on your own or take the instrument to an outside source for repair as it will void this coverage.
5 A claim for repair or replacement does not alter the rental agreement.
6 The instrument is protected by this optional coverage when selected and provided your account is current.
7 Pricing for coverage is as follows: Group 1 is $5.00, Group 2 is $6.00, Group 3 is $7.00.