Village Music Shoppe 1495 Montauk Highway, Mastic, New York 11950 1-631-874-8425 www.villagemusicshoppe.com Rental Contract                                                                         Expires: _______________
Instrument		Serial #____________
Value______________
The Rental period is Beginning_____________and Ending___________
Rental Cost $_______ + Damage Protection $_______ + Tax $______+ Total $_______
Terms and Conditions of Damage Protection Plan agreed to by____________________________
Upon delivery of the above mentioned instrument, the following conditions must apply: I agree to return instrument in as good condition as when received, Less reasonable wear. I agree to repair, at my own expense, any damage not covered by the damage protection plan (if purchased), such as denting or breaking, while instrument is in my care and possession. In the event the intrument is lost or stolen, I agree to pay the value of the instrument as stated above. I agree to notify Village Music Shoppe immediately of any change of address or telephone number. I agree that the instrument must be returned within five days after rental peroid expires, otherwise there is a charge of $___________per week from the date of expiration. I will pay all fees necessary for any legal restitution of the merchandise or for collection of monies past due. As long as lessee is not in default of any monies owed to Village Music Shoppe pursuant to this agreement or rental agreements, Village Music Shoppe, subject to the provisions of paragraph 4 of this agreement, will make all repairs(including replacments of parts, but excluding repairs and replacements required because of damage intentionally caused or caused due to neglect or misuse) which may be required during the term of said lease, in order to keep the rented/leased instrument in good operating condiction. If the rented/leased instrument and original rental/lease plan provisions shall be in effect. Village Music Shoppe shall not be obligated to restore the finish of any instrument or replace broken parts, such as mouthpiece caps, ligatures, bows, bridges and cello floor pegs. Terms and conditions agreed to by:__________________________________________               Signature of Lessee
Lessee Name	Home Address	Home Phone Cell phone Number
Business Name	Business Address	Business Phone
NYS Driver's License No.		Child's Name, Relation and School
Card Type Visa Master Card Discover	Credit Card Number (you must bring card to verify number)	Expiration Date
If for any reason we can not collect the instrument and or damage or late fees. We will charge it to the above Credit Card.
________________________________                                __________________ Signature of Release                                                                     Date of Contract
Fill Out all white Boxes with your information, print 2 copies of this form and bring them, a New York State Drivers License and the Credit Card you used, along with you to the store to Pick-up Your Instrument. Availability of Instruments is not Guaranteed

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