Owner & Instrument/Equipment Information: |
Instrument or Equipment Owner's Name:
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Is this for:
Individual
Band
Orchestra
Studio |
Band or Studio Name (if applicable):
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Type of Instrument or Equipment (#1):
Brand or Make of Instrument or Equipment (#1) (Gibson, Fender, Neve, etc.):
Model or Style of Instrument or Equipment (#1) (Les Paul, Stratocaster, 5088, etc.):
Year of Instrument or Equipment (#1) (1952, etc.):
Estimated Value of Instrument or Equipment (#1):
$
Type of Music Primarily Played with this Instrument or Equipment (#1):
Non-Classical/Rock/Pop
Classical/Orchestra |
Type of Instrument or Equipment (#2):
Brand or Make of Instrument or Equipment (#2) (Gibson, Fender, etc.):
Model or Style of Instrument or Equipment (#2) (Les Paul, Stratocaster, etc.):
Year of Instrument or Equipment (#2) (1952, etc.):
Estimated Value of Instrument or Equipment (#2):
$
Type of Music Primarily Played with this Instrument or Equipment (#2):
Non-Classical/Rock/Pop
Classical/Orchestra |
Type of Instrument or Equipment (#3):
Brand or Make of Instrument or Equipment (#3) (Gibson, Fender, etc.):
Model or Style of Instrument or Equipment (#3) (Les Paul, Stratocaster, etc.):
Year of Instrument or Equipment (#3) (1952, etc.):
Estimated Value of Instrument or Equipment (#3):
$
Type of Music Primarily Played with this Instrument or Equipment (#3):
Non-Classical/Rock/Pop
Classical/Orchestra |
Primary Physical Address of Instrument (P.O. Boxes Not Accepted):
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City:
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State:
|
Zip Code:
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Phone Number:
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Email Address:
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Yes
No |
Yes
No |
Yes
No |
Yes
No |
Yes
No |
Yes
No |
Yes
No |
Yes
No |
Yes
No |
Bank Vault
Premise Safe
Neither |
Local Alarm
Concierge
Private Security
Central Station Alarm
None |
Bar
Nightclub
Restaurant
Symphony/Orchestra
School
Private |
How Many Years Have You Owned Professional Musical Instrument(s) or Equipment?:
|
How Many Years Have You Been a Professional Musician?:
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How Many Times a Year Do You Ship an Instrument or Equipment via a Common Carrier (FedEx, UPS, etc.)?:
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How Many Days Per Year Do You Travel With Your Instrument or Equipment?:
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Commercial Building
Private Residence |
Yes
No |
Yes
No |
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Additional Comments:
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Please let us know how you found us:
Google
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Yahoo!
Other:
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