On-Approval Form

Date(Required)

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone(Required)

**must include area code**

Email(Required)

Credit Card(Required)

American Express

Discover

MasterCard

Visa

JCB

Maestro

Card Number

Expiration Date

Security Code Cardholder Name

The card will not be billed unless the instrument returns with damage or the instrument(s) are purchased.

I HEREBY ACKNOWLEDGE RECEIPT OF THE FOLLOWING MERCHANDISE TO BE TAKEN FROM GUARNERI HOUSE ON TRIAL, AND I ACCEPT FULL LIABILITY IN CASE OF ACCIDENTAL SHIPPING LOSS, DAMAGE, FIRE, THEFT, VANDALISM, ETC.(Required)

Agree

Value of Instrument(Required)

Serial Number(Required)

Description(Required)

Known Damage(Required)

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Value of Instrument(Required)

Serial Number(Required)

Description(Required)

Known Damage(Required)

IF NOT PURCHASED, THE MERCHANDISE MUST BE RETURNED IN THE SAME CONDITION AS WAS RECEIVED WITH IN 10 DAYS OF THE DATE ABOVE. IF SHIPPING TO GUARNERI HOUSE, USE UPS OR FEDEX. ARE ITEMS MUST BE INSURED FOR FULL VALUE, AND TRACKING INFORMATION SUPPLIED TO GUARNERI HOUSE.(Required)

I acknowledge

Type Name of Responsible Party(Required)

Student's Name & Number (IF APPLICABLE):

Teacher's Name & Number (IF APPLICABLE):

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On-Approval Form

On-Approval Form

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