5842 Merriam Drive - Merriam, KS 66203 - (913) 677-0400 Fax: (913) 677-4506 www.kcstrings.com                  Use browser's "back" button to return to Instrument Approval page. Instrument Approval Agreement  Date:  Customer Name: Address:       City: State: Zip: Phone: Home (_____) __________________  Email:  Cell (_____) __________________ Driver's License No.: CC No.:   Exp. Date:  ____ /____ CVC No.:   Private Lessons Teacher: I agree to assume full responsibility for the care of the items listed below, which have been released to me on approval, and to return the items in the same condition in which I received them, should I decide not to purchase them.   If the items are not returned by agreed time, and no other arrangement is made, the items will be considered rented and a fee of ____________________/month will be charged to the credit card number above.  [Monthly rental is determined by the retail cost of the items divided by 12.] Date: Items: Price: _____________ _____________________________________ _______________ _____________ _____________________________________ _______________ _____________ _____________________________________ _______________ _____________ _____________________________________ _______________ _____________ _____________________________________ _______________ _____________ _____________________________________ _______________ I agree to  return  items in: ________________________________ ________________________________ ____________                     Customer Signature Shop Authorization Notes:_______________________________________________________________________  ____________________________________________________________________________