This form will ask you several questions about you, your child enrolling in band, and it will gather the data we need to deliver your band instrument on time.
Awesome! Let's go! (click here to proceed).
What is your FIRST name? (FIRST Name of Parent or Guardian)
Hello [s2]! What is your LAST Name?
What is your e-mail address?
What is your Mobile Phone Number?
What is your Home Address? Please include the Street, City, State, and Zip Code.
Awesome [s2]! We're almost done with the first section! We just need two references to contact in case we can't reach you by the phone or your information has changed.
Continue to enter first reference (click to continue)
Please enter the First and Last Name of your FIRST reference.
What is [s8]'s telephone number?
Please enter the First and Last name of your SECOND reference.
What is [s9]'s telephone number?
Awesome [s2]! You're done with the First Section. There are only two more short sections left.
Click here to continue
What is the name of the child that will be playing this instrument? Please enter their FIRST NAME ONLY.
What is [s11]'s LAST name?
What instrument will [s11] be playing in band?
Clarinet ($28 monthly rental)
Flute ($28 monthly rental)
Trumpet ($28 monthly rental)
Trombone ($28 monthly rental)
Saxophone ($45 monthly rental)
Percussion ($32 monthly rental - you will own after 9 months)
What School will [s11] be attending band class?
What is your relationship to [s11]?
Mother
Father
Grandparent
Guardian / Other
This is the final section. We're almost done! In this section we will collect your payment information for the rental instrument.
Click here to proceed
We do processing by credit card. Your card will be charged on the day that you define. What day of the month would you like to be charged? (the last day of the month that we can charge is the 28th of the month).
The 1st Day of The Month
The 5th Day of The Month
The 10th Day of The Month
The 15th Day of The Month
The 20th Day of The Month
The 28th Day of The Month
Awesome! Your card will be charged on [s15] for rental of the [s13].
Click to proceed.
What is your credit card number?
What is the expiration date?
What is the Credit Card Validation Number? (Visa and Mastercard use a three digit code on the back. American Express uses a 4 digit code on the front).
What is your Credit Card Billing Address? Please include: Address, City, State, Zip.
We're almost done, [s2]. Please agree to the terms and conditions to complete the user agreement but READ THIS FIRST. Please note that since you are filling the form out online, we will deliver a starter pack when we deliver your instrument. The starter pack inlcudes a music stand, book, music folder, cleaning supplies, and anything else you need to get started. The starter pack cost varies depending on what school your child attends. It's usually $30 for brass instruments and $35 for woodwind instruments. We will charge your account for the starter pack before we deliver your instrument to ensure that we have all of the correct account information.
Please click submit to submit your information to Pladd Dot Music!
We have recieved your submission.
Dear [s2] [s3],
We have received your form submission for your rental contract and we will process it shortly. We will contact you if we have any questions.
Thanks!
The Pladd Dot Music Team
We have received your form submission for your rental contract and we will process it shortly. We will contact you if we have any questions.
Thanks!
The Pladd Dot Music Team
Renter Information:
_____________________
First Name: [s2]
Last Name: [s3]
Relationship to Student: [s13c]
E-mail Address: [s4]
Mobile Phone Number: [s5]
Address: [s6]
References:
______________________
First Reference: [s8]
First Reference Phone Number: [s8b]
Second Reference: [s9]
Second Reference Phone Number: [s9b]
Child Information:
_______________________
Name of Child: [s11] [s12]
Instrument: [s13]
School Attending: [s13b]
Payment Information:
________________________
Day of the month to charge: [s15]
Credit Card Number: [s17]
Credit Card Expiration: [s18]
Credit Card Validation: [s19]
Credit Card Billing Address: [s20]
Terms and Conditions: I Agree to the terms and Conditions of the Rental Agreement located at: http://www.pladdmusic.com/page9/rental
_____________________
First Name: [s2]
Last Name: [s3]
Relationship to Student: [s13c]
E-mail Address: [s4]
Mobile Phone Number: [s5]
Address: [s6]
References:
______________________
First Reference: [s8]
First Reference Phone Number: [s8b]
Second Reference: [s9]
Second Reference Phone Number: [s9b]
Child Information:
_______________________
Name of Child: [s11] [s12]
Instrument: [s13]
School Attending: [s13b]
Payment Information:
________________________
Day of the month to charge: [s15]
Credit Card Number: [s17]
Credit Card Expiration: [s18]
Credit Card Validation: [s19]
Credit Card Billing Address: [s20]
Terms and Conditions: I Agree to the terms and Conditions of the Rental Agreement located at: http://www.pladdmusic.com/page9/rental
Thanks! We're processing your information now. You will get an e-mail confirmation soon! If you DO NOT get an automatic reply, please contact us at: (912)764-3230.
Pladd Dot Music is Located at:
38 North Main Street
Statesboro, GA 30458
(912)764-3230
Statesboro, GA 30458
(912)764-3230
About us:
Pladd Dot Music specializes in music lessons, band and orchestra rentals and repair, and music retail. Feel free to give us a call or contact us via this website!