Musical Instruments Repair Services

Student Name*
First Last
Parent Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Contact Phone Number*
Contact Email*
Type of Instrument*
Make
Optional
Serial Number
Optional
Details of Repair Needed
Approved $ Amount*
- OK to $40.00
- Call With Estimate First
School Student Attends*
Director's Name
Select how you would like your instrument returned to you
- Deliver to my school (same location as it was picked up from)
- Pick up at Defiance Store
- Pick up at Lima Store
- Pick up at Toledo Store
- Pick up at Westlake Store
- Pick up at Dublin Store
Additional Comments