Rental Application

Fill out the form below, print and mail or fax it to,        

 Gadsden Music Company, Inc.

P.O. Box 132     

fax 256-546-7274

   Gadsden, AL 35902-0132

Please provide the following contact information. Incorrect or missing information causes delays.

Student's NameGrade
School Instrument selected 
Have you ever had an account with us before?   YES NO |____|
ApplicantSocial Security#
Spouse   Social Security#
Mailing Address
City/State/Zip 
Home Phone(area code&number) 
Previous Address(if less than one year at present address) 
        
Applicant's EmployerHow Long?
Employer's AddressPhone    
Name and Address of Applicant's nearest living relative(not living with you)

Phone
Name and Address of Spouse's nearest living relative(not living with you

Phone
I hearby authorize the person to whom this application is made or any Credit Bureau or any other
investigative agency employed by such person to investigate the references herein listed or 
statements or other data obtained from me or any other person pertaining to my credit and 
my financial responsibility. I Agree and Accept
signed ______________________________________________________________________

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