Admin Only Agreement No. Paperwork Sent: WOODWIND INSTRUMENT SPECIALISTS Howarth of London – Rental Scheme Application (website) ALL SECTIONS MUST BE COMPLETED PRIOR TO RENTAL OF THE INSTRUMENT Hirer (must be over 18): …………………………………………………………………………….……….……………………………………..……. Address: …………………………………………………………………………………………………………………………..................... ………………………………………………………………………… Postcode: …………………………….………..……….. Home Tel: ………………………………………….................... Mobile: …….……………………………………………..…..…… Email: …………………………………………………………………………………………. Date of Birth: ....…/…..…/………... Child’s School (if relevant): ……………………………………………………………………………………………..……………………………... Teacher/Music Service (if relevant): ……………………………………………………………………………………………………………..… Instrument Oboe: Junior - Student - Intermediat e - Advanced Bassoon: Mini - Tenoroon - Fagonello - Short-Reach - Standard - Graduate Clarinet: Beginner - Graduate- Nuvo/Junior (special request) Sax: Soprano - Alto - Tenor - Baritone - Alpha Flute: Curved-head Flute - Standard Flute Employer Contact Details: Bank Details: Name: …………………………………………………………….. Account Holder: …………….……................................. Address: …………………..………………………………………… Sort Code: …………………….……….……………................. ……………………………..…………………………………..……….… Account Number: …………………………........................ ………………………..…………………………………………………… Bank Name: …………………………………….………………….. Postcode: …….……..….…………………………………………… Bank Address: ………………..…..………….…………………… Tel: .......................................................................... …………………………………………………............................ ………………………………… Postcode: ……………...…..…… Customer Declaration: I consent to a credit check prior to renting and certify that all sections are complete and correct. Customer Signature: ………………………….………………………………………………… Date: …….../…..…../…………. Please post, or email this form to the London Shop, details listed below. Instrument rental is subject to credit approval; on acceptance we will send you the Rental Agreement Contract and Direct Debit Instruction for your signature and return. The instrument will be available on receipt of the signed contract. You can arrange to collect the instrument from London or Worthing, or we can send it to you at current postal rates. Please note, this is a rental only scheme and at no point are you purchasing the instrument. Registered Office & Showrooms: 31 Chiltern Street, London W1U 7PN Tel: 020 7935 2407 Email: [email protected] Web: www.howarthlondon.com Howarth of London Ltd Registered in England and Wales No. 492396 VAT No. GB 283 1051 27 Director: J Walsworth .