Ken Stanton Music Online Instrument Rental Application

Applicant Information Section
Responsible Party Name:*
PrefixFirstLastSuffix
The person who will be responsible for the payments of the instrument
Address*
Street AddressAddress Line 2CityStateZip Code
Time you have lived at the above address in years and months*
Example: 5 Years/3 months
Housing status*
Monthly Rent or mortgage payment amount*
Example: 1000.00
Monthly Household Income Amount*
Example: 4000.00
Primary Phone Number*
A working & valid phone number.
Work phone number*
Cell phone number*
Email address*
Enter EmailConfirm Email
A vaild and working email address
The last 4 digits of your Social Security Number (SSN)*
Name of nearest relative*
FirstLast
The name of your nearest relative not residing with you.
Relationship*
How are you related to this person?
Relative's Address*
Street AddressAddress Line 2CityStateZip Code
Relative's phone number*
A working and valid phone number.

Student Information Section
The student who will be in possession of the instrument.
Student's name*
FirstLast
Student's school name*
The name of the school the student attends
Student's grade level*

Credit Card Information Section
Credit card type*
The last 4 digits of your credit card number*
Credit card expiration date*
Example: 06/14
Name as it appears on the card*
FirstLast
To receive an instrument, I authorize Ken Stanton Music, Inc. to use my Credit Card provided as Security and to automatically debit the card for any past due balance from my Lease-Purchase Agreement to this account. Ken Stanton Music, Inc. is not responsible for any bank fees or overdraft fees which occur from the use of this card. By submitting this application online, I am agreeing to the above terms.*
- I agree with the above statement
Completion of a credit application does not guarantee an approved rental. To receive new or certain types of instruments, customer agrees to allow us to obtain a copy of a personal credit report today. By signing below, I am authorizing Ken Stanton Music, Inc. to charge any past due balance from my Lease- Purchase Agreement to my credit card. You also agree to allow us to obtain a copy of a personal credit report at any time. By submitting this application online, I am agreeing to the above terms. *
- I agree with the above statement

Peace Of Mind (POM) Plan Section
Ken Stanton Music's POM program
The Peace of Mind Plan (POM) offers conditional maintenance and replacement coverage for the instrument for a small monthly fee. It is strongly recommended. The POM is only offered when the agreement is initiated and cannot be added later.

If POM is not purchased, Lessee will be responsible for all maintenance and service on the leased instrument at Lessee's expense, and will be responsible for loss, theft, damage in excess of normal wear and tear, or destruction of the instrument at the cost ranging from a minimum repair fee ranging from $85 - $150 (dependent upon instrument class) up to a maximum of the Instrument's Fair Market Value.

If POM is not purchased, there will be a minimum repair fee ranging between $85 - $150 (dependent upon instrument class) up to a maximum of the instrument's Fair Market Value to refurbish the instrument if returned.

Lessee is not required to purchase the Peace of Mind Plan, and it may not be available on all types of instruments.
Do you wish to purchase the Peace Of Mind plan?*
If POM is not purchased, there will be a minimum repair fee ranging between $85 - $150 (dependent upon instrument class) fee up to a maximum of the instrument's Fair Market Value to refurbish the instrument if returned.*
- I agree to the repair fee.

Rental Pickup Infomation Section
How would you like us to contact you regarding your rental application?*
Select the Ken Stanton Music location or affiliate store where you would like to pick up and pay for your rental instrument: *

Application Verification & Submission
I verify that all the information in this electronic rental application is true and factual. I understand that this is an electronic application only, and is subject to approval. This electronic application is not a rental agreement contract.*
- I agree to the above statement
Digital signature
PrefixFirstLastSuffix
By typing your name above, you hereby agree to all terms set forth by this electronic application document. Your typed name shall be treated as your legal signature within the context of this electronic online rental application.
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