Lease Agreement.

Date ____________________ Instrument ___________________________

Make ___________________ ID# _______________ Value _____________

Lease through ___________________ Date Due _____________________

Lease Fee ___________ + Insurance ____________ = ________________

This instrument remains the property of Community Music School. All repairs not due to theft or loss will be made without any further charge to the lease. If you opt not to receive maintenance coverage, any and all repairs will be handled by you. In case of theft or loss, the value of the instrument must be paid to Community Music School. If the instrument is returned later than January 3, 2005, a $1 per day late fee will be charged.

________________________________
Name (Printed)

________________________________
Signature of Parent/Guardian

Home Phone ____________________ Work __________________________

Address _________________________________________________________

Student's Name __________________________________________________

Class __________________________ Teacher _________________________

Print or download the Lease Agreement, complete the information required and return it to:

Community Music School
14 Monument Square,
Suite 406,
LEOMINSTER, MA 01453

Completed forms may also be faxed to: (978) 840-1000