5842 Merriam Drive - Merriam, KS 66203
Phone: (913) 677-0400
Fax:      (913) 677-4506
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Instrument Approval


Date:  ____________________________


Customer Name: _______________________________________________________

Address: _____________________________________________________________

      City: ___________________________________ State: ________ Zip: ________

Phone: (Home) (_____) __________________  (Work) (_____) _________________

(Drivers License No.: ______________________________

MC / VISA No.: _______________________________ Exp. Date: _____________ 
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 item(s) in the same condition in which I received them, should I decide not to purchase it/them.
Date: Items: Price:
_____________ _____________________________________ _______________
_____________ _____________________________________ _______________
_____________ _____________________________________ _______________
_____________ _____________________________________ ______________
_____________ _____________________________________ _______________
_____________ _____________________________________ _______________

I agree to return 
item(s) in:

_______________

 __________________________________ _______________
Customer Signature Shop Authorization
Notes:_______________________________________________________________________

____________________________________________________________________________