Instructions for completing this form.

1.  Complete this form using your computer keyboard.
2.  Print the completed form and mail it to 28-174 Colonnade Rd. S Nepean, ON K2E 7J5.  (All fields are required)
3.  Upon receipt of your form, please allow two business days for processing.
4.  For faster (same-day is possible!!) service, fax your form to 727-0090.
5.  You will be contacted to finalize your request and discount.
Providing all the following information will ensure an immediate  reservation for your instrument.

First, Last Name   Initial
Spouse's First, Last Name Initial
Street address Apt #
City Province Postal Code
Home Phone    Work Phone 
Email Address
Verify Email Address
Employer   How Long
Drivers License #   Date of Birth / /
Credit Card VI  MC  #  - - - Exp /    I don't have a credit card
Three digit verification code    What is this?
Name on credit card
Student's First, Last Name Initial
Student's School
Teacher Grade (Going into in September)
Instrument Requested
Referral Customer's Last Name Home Phone #