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Size options
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1/2
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Auto Payment Authorization
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 I authorize Centreville Music Shop to charge REGULAR MONTHLY FEES without any discount after the paid term is over until the instrument is returned or paid off WITH THE SAME CARD THAT WILL BE USED TO PROCESS THIS ORDER or with a newly updated card in the future. I will update the card information as soon as any information is changed by phone, in person or electronically.
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Non proration Month-to-Month plan
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I acknowledge my monthly billing date will be the same as contract date each month and NO PRORATION shall be made for rental payments based on the day of return.
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Verification
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I will bring my driver’s license for verification.
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Print Legal Name
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ki mi
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