Note: This is not an actual rental contract form. This form will be e-mailed to us and an educational representative will contact you. Please be sure to leave all necessary information. Remember, the rental contract agreements are not in effect until you, the customer, sign the actual form.
All plans are available to Rio Grande Valley residents only.
NO OUT OF AREA SUBMISSIONS PLEASE.

STUDENT INFORMATION
Student Name:
School: Alton Elementary School Brownsville Bisteiro Brownsville Central Brownsville Lucio Brownsville Oliviera Brownsville Pace HS Brownsville Perkins Brownsville St. Joseph's Academy Brownsville Stell Brownsville Vela Donna Solis Donna Veterans Edcouch Elsa Junior High Edinburg B.L. Garza Edinburg Harwell Edinburg Memorial Edinburg South Edinburg Teachers Academy Falfurrias Junior High Harlingen Coakley Harlingen Gutierrez Harlingen Memorial Harlingen Vernon Kingsville Gillette La Joya Ann Richards La Joya Chavez La Joya Dezavala La Joya Memorial Lyford Middle School McAllen Brown McAllen Cathey McAllen DeLeon McAllen Lincoln McAllen Morris McAllen Travis Mercedes Discovery Mercedes Graham Mission Bryan Elementary Mission Castro Elementary Mission Cavazos Elementary Mission Junior High Mission Leal Mission Mims Mission White Port Isable Jr. Hi PSJA Alamo PSJA Austin PSJA LBJ PSJA North HS PSJA Veterans Raymondville Green MS Rio Grande City La Grulla Rio Grande City Ringgold Rio Hondo MS Roma ISD San Benito Berta Cabaza San Benito Miller Jordan Sharyland Garza Sharyland Gray Junior High Sharyland Hinojosa Sharyland Jensen Elementary Sharyland John Shary Sharyland Martinez Weslaco B. Garza Weslaco Central Weslaco Cuellar Weslaco High School Weslaco Mary Hoge Academy Zapata Middle School Unlisted School
If your school is not on the list:
Unlisted School Name:

BILLING INFORMATION
Customer Name:
Street:
City:
State: Texas Not Available Out of Valley
Zip:
Phone:( )
Contact E-mail:

INSTRUMENT
Please select the instrument your child will be needing from the list below. Students for stringed instruments need to have a size specified before submission.

Open Hole Flute Closed Hole Flute Plastic Clarinet Wood Clarinet Alto Saxophone Soprano Saxophone Tenor Saxophone Cornet Trumpet

Trombone Nylon Guitar Percussion Kit/Bell Percussion Kit/Snare Percussion Kit/Bell & Snare Violin (size) 4/4 3/4 1/2 1/4 1/8 1/16 1/32 Viola (size) 17+ 16 1/2 16 15 1/2 15 14 13 12 Cello (size) 4/4 3/4 1/2 1/4 Bass (size) 3/4 1/2 1/4

Need a care kit for an instrument you already have? Select one from below:
When getting an instrument under the Rental-Purchase Plan, a care kit for your instrument is included FREE!!
Care Kits: Alto Sax Kit Baritone Saxophone Kit Bass Clarinet Kit Bassoon Kit Clarinet Kit (Plastic) Clarinet Kit (Wood) Cornet Kit (Lacquer) Cornet Kit (Silver) Euphonium Kit (Lacquer) Euphonium Kit (Silver) Flute Kit French Horn Kit (Lacquer) French Horn Kit (Silver) Oboe Kit Tenor Sax Kit Trombone Kit (Lacquer) Trombone Kit (Silver) Trumpet Kit (Lacquer) Trumpet Kit (Silver) Tuba Kit