"*" indicates required fields Account Holder Name* First Last Email* Phone*Number of Payments Being Made*CommentsHave over 6 instruments to pay towards? Please submit the form below with up to 6 instruments and start again to process additional payments, or give us a call at 1-800-52-MUSIC!Student 1 Name*Student 1 Instrument*Student 1 Payment Type*Please SelectAuto-Bill - Rental PaymentOne Time - Rental PaymentService and Maintenance - Rental PaymentRepair - One Time PaymentStudent 1 Payment Amount* Student 2 Name*Student 2 Instrument*Student 2 Payment Type*Please SelectAuto-Bill - Rental PaymentOne Time - Rental PaymentService and Maintenance - Rental PaymentRepair - One Time PaymentStudent 2 Payment Amount* Student 3 Name*Student 3 Instrument*Student 3 Payment Type*Please SelectAuto-Bill - Rental PaymentOne Time - Rental PaymentService and Maintenance - Rental PaymentRepair - One Time PaymentStudent 3 Payment Amount* Student 4 Name*Student 4 Instrument*Student 4 Payment Type*Please SelectAuto-Bill - Rental PaymentOne Time - Rental PaymentService and Maintenance - Rental PaymentRepair - One Time PaymentStudent 4 Payment Amount* Student 5 Name*Student 5 Instrument*Student 5 Payment Type*Please SelectAuto-Bill - Rental PaymentOne Time - Rental PaymentService and Maintenance - Rental PaymentRepair - One Time PaymentStudent 5 Payment Amount* Student 6 Name*Student 6 Instrument*Student 6 Payment Type*Please SelectAuto-Bill - Rental PaymentOne Time - Rental PaymentService and Maintenance - Rental PaymentRepair - One Time PaymentStudent 6 Payment Amount* Address* Street Address City State / Province / Region ZIP / Postal Code Credit CardPlease do not insert dashes in the credit card number. American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name CAPTCHA