Instrument Rental Return Request

Parent's Name: Student's Name: Street Address: City / State / ZIP: Cell Phone Number: Email Address: Music Teacher: School: Instrument Type:

Is the instrument currently at:

What date will you be finished with the rental?:

Will the student be continuing in band or orchestra when school resumes?:

Comments / Special Pickup Constraints / Etc:

You may skip this form and return your rental to our retail store during business hours (map below):

Monday - Friday 2:00 PM - 6:00 PM

Saturday 10:00 AM - 2:00 PM

For your ultimate convenience, we are providing free, contactless home and school pickups and deliveries, so we can come to you!

Please fill out this form and we will be in touch to schedule a pickup day and time. Please allow up to one week for scheduling.

Your automatic payments will be suspended upon receipt of this completed form.

(608)-756-0018

Please email us for fastest response outside of business hours.

Questions? Email us!

Voigt Music Center

2152 W US Highway 14

Janesville, WI 53545