Tune America
"Everything Piano"
Rental Application Form

 
Serving the United State of Texas

 

Line-new Young Chang Pianos

State-of the-art Digital Pianos

New Pianos from Samick

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Please fill in all information carefully.
Note:This form uses a secure connection
to protect your information.
Full Name:
Full Current Street Address:
City or Town:
Zip Code:
How Long?
Years:
 
Months:

() Own () Rent () Other
Home Phone:
SS #
TDL#
D.O.B.must be over 21 years of age
Employer
Employers Full Address
 Zip
Work Phone w/ext
 Supervisor
How Long?

Years:
 
Months:
Closest relative not living with you:
Address:
 Zip
Phone:
 Relationship:
Current Visa/Mastercard/American Express/Discover or Harmony in your name.
All piano renters must have open bank card account.
Your name as on card
 Type of card?
Card #
 Expiration Date:
I certify all above information is correct and authorize Tune America access to my credit report to qualify my application to rent a piano.

Please Note:
Entering your name,email and todays date in the following represents your signature of acceptance of all of the above terms.
And that you have read and accept the Rental Terms and Policy
Name:
 Date:
Your Email Address:
Instrument Choice:
Comments Questions and Suggestions:
Please      
 
JW Cusack
6920 Fairbanks-North Houston Road
Houston Texas 77040
Houston: 713-937-9213   Austin: 512-940-0874
Toll-Free: 800-787-5760   Fax: 713-937-0569

www.Rent-a-Piano.com