School Instrument Rental AgreementInstrument Rental Agreement • January 31st, 2022
Contract Type FiledJanuary 31st, 2022Niemann & Sons Music 3555 E. LincolnwayCheyenne, WY 82001(307) 637-5222 1. Responsible Party Information (Please Fill in Completely) Dated Parent’s Name: Previous Customer? (Y/N) Address: How long? Phone # City: State: Zip: Social Security Number: Employer: Work Phone: Cell Phone: E-Mail: Financial Institution (name of bank) 9 digit routing #_________________________Checking Account #________________________ Name as it appears on account_________________________Driver’s License #: Date of Birth: Alternate Contact: Contact phone: (If PO Box is listed above)For your convenience, we will automatically post your monthly payments to the checking account provided for this account. Should you choose to decline the Auto Pay feature, however, Niemann Music, Inc reserves the right to charge all payments and late fees to your checking account should the account become 30 days delinquent. Initial here if you wish to decline Auto Pay >>> Student Info:Student’s First & Last Name: Address where ins