<p> Lydia Music Center 9000 Perry Highway Instrument Rental f Pittsburgh, PA 15237 Agreement Form f </p><p>Student Information: Student Name ______School District ______Grade _____ Music Teacher ______Billing Information: Customer Name ______Drivers License ______Street Address ______City______State ______Zip Code ______Home Phone ______Cell Phone ______Email Address ______</p><p>Rental Instrument Information: please check the instrument of your choice</p><p>Damage Protection Plan Violin/Viola $2/month (optional) Cello $4/month Bass $6/month $ ______Accessories Shoulder Rest: Sponge H $25.00 Everest H $18.00 $ ______</p><p>Rockstop $10.00 $ ______Music stand $13.00 $ ______Cleaning kit $20.00 $ ______TOTAL $ ______Payment Options: Cash Check : payable to Lydia Music Center, 9000 Perry Highway, Pittsburgh, PA 15237 Credit Card (charged monthly) ○ Visa ○ Mastercard ○ Discover Name on Card ______I authorize Lydia Music Center to charge monthly instrument rental payments to this credit card. E Exp Date: / CVV Code: Signature: E </p><p>Terms and Conditions of Lydia Music Center's Instrument Rental Program 1. The accumulated value of the first 24 months of rental payments can be contributed to the purchase of a new (but same type of) instrument. Credit cannot be applied to repairs or accessories. Credit is also non-transferrable and cannot be combined with another rental account. 2. The renter assumes liability for the instrument during the rental period. If the instrument is lost, stolen, or damaged, the renter will reimburse Lydia Music Center for the repair or replacement cost. However, instrument maintenance for normal use or weather related adjustments are included free of charge throughout the rental period. 3. The optional damage protection plan covers accidental damage to the instrument. The first incident of accidental damage will be covered 100% by Lydia Music Center, and each subsequent accident will be covered 15%, meaning the renter will need to pay for the other 85% cost. This plan does not cover loss, intentional damage, or string replacement. 4. Any instrument or bow can be exchanged for another size at any time at no additional charge. 5. Payments are due on the 5th of every month. If a rental payment is not received within 5 business days after the due date, a late fee of $5.00 will be charged to the account. Late fees do not add to customer's equity for instrument purchase option. 6. A $20.00 fee will be charged for checks returned for any reason 7. All accounts that are seriously past due are turned over to collection agencies. If the renter makes no payments after 60 days, the instrument will be considered purchased. The current market value of the instrument plus all late fees incurred will be billed to the account immediately. In addition, the account will be billed for all collection, expenses, court costs, and attorney fee. I have read this contract and agree with the terms and conditions.</p><p>Customer Signature ______Date______</p>