One-Day Rental Form

Name*

First Last

How Would You Like Us to Contact You?*

(Select All that Apply)

Home Phone
Cell Phone
Work Phone
Email
Mail

Home Phone

Cell Phone

Would You Accept Text Messages?

Yes
No

Work Phone

Email

Confirm Email

Address*

Street Address Address Line 2 City State ZIP Code

Date(s) needed for piano rental:*

Location piano is to be delivered to:*

Street Address Address Line 2 City State ZIP Code

Inside

Flooring*

Carpet
Wood
Ceramic Tile
Other

If "Other," Please Specify.

Sharp turns?*

Yes
No

(less than 6' clearance)

Length

Width

Any inside steps?*

Yes
No

How Many Steps Inside?*

Type of Steps

Carpet
Wood
Concrete
Other

If "Other," Please Specify.

Will the Piano Be Going Up or Down the Steps?*

Up
Down
Both

Please Specify.

Are the Steps Facing a Wall?

Yes
No

Any Turns at the Top or Bottom of the Steps?*

Yes
No

Length

Width

Any Turns/ Landings on the Steps?*

Yes
No

Number of Landings

Length

Width

Notes

Outside

Can Our Truck Back up to the door?*

Yes
No

If "No," how far (in feet) will the truck be from the house?*

Path to the Door*

Sidewalk
Grass
Stone
Brick
Other

If "Other," Please Specify.

Degree of Any Slopes

Any outside steps?*

Yes
No

Number of Outside Steps*

Type of Steps

Concrete
Wood
Brick
Other

If "Other," Please Specify.

Will the Piano Be Going Up or Down the Steps?*

Up
Down
Both

Please Specify

Any turns/ landings on the steps?*

Yes
No

Number of Landings

Length

Width

Do You Have Any Photos of the Delivery Location that You Can Post? If so, How Many?

One
Two
Three

Post Photo Here

Second Photo

Third Photo

Notes

How Did You Hear About Us?

Family/Friend Referral
Facebook
Newspaper/magazine Ad
Other Website
Internet Search
Event
Other

Which Newspaper/ Magazine?

Which Website?

Which Event?

If "Other," Please Specify.

Services

Inside

Outside

Thank You