Musical Instrument Repair Form	KOHN MUSIC STORE 54 S. Elk Street PO 167 Sandusky, MI 48471-0167 Telephone 810.648.2095 TOLL FREE 866.406.4666 FAX 810.648.2049 www.kohnmusicstore.com	Repair Tag Invoice #
PLEASE PRINT AND FILL OUT COMPLETELY PLEASE SIGN FORM

Student Name	School
Parents Name	Home Telephone w/area code
Address
City	Zip CODE	E-mail
Father's Daytime Telephone	Mother's Daytime Telephone
Instrument Serial Number	Instrument Brand	Instrument Type
ALL REPAIRS ARE TO BE PAID UPON COMPLETION To ensure rapid delivery of your child's instrument back to school, we have asked for daytime telephone numbers. You will be called before delivery is made with the exact price of the repairs. Please send a check payable to KOHN MUSIC STORE to the above address. Should you decide to pay by credit card, you may give the number, along with the expiration date over the telephone or write the information below. _____VISA _____Mastercard _____Discover _____American Express Card #____________________________________________ Exp. Date____/____ Initials__________
REPAIRS TO BE DONE
____ PUT IN GOOD PLAYING CONDITION: We will do whatever is necessary to put your instrument in proper playing condition. We will not do any more than is required and we will do it as inexpensively as possible. ____ PLEASE DO ONLY THE FOLLOWING: _________________________________________________________________________________________ _________________________________________________________________________________________ PLEASE CALL OR SEND AN ESTIMATE We are glad to, however, by the time we get authorization to proceed, we may m8iss your next weekly service call to your school. If our estimate is less than $25, we may proceed with the repair, anticipating that you would certainly want the repair done and the instrument returned as soon as possible.
MUST BE SIGNED AUTHORIZATION
*PLEASE DO NOT WRITE BELOW THIS LINE*
*PICKUP DATE*	*SCHOOL SERVICE REPRESENTATIVE / REPAIRED BY*	*INVOICE DATE*
*DATE RETURNED*	*ESTIMATE*	*APPROVED BY*
DESCRIPTION OF REPAIRS DONE TO INSTRUMENT








TOTAL OF ALL REPAIRS=