This form to be filled out by store clerk who issues you the instrument

Salesperson's Name
Customer Name *
Customer Name
Name as appears on the credit card used for payment
Damage Liability *

In confirming this rental, I verify that I am 18 years old or older and that: 1) that I reserve the right to return the instrument at any time; 2) that the full title and ownership of the instrument will remain with Rockin’ Robbie’s, Inc.; 3) that I will not sell, loan, mortgage, or dispose of the instrument that is being rented; 4) that I will pay all costs of replacement or repair in the event the instrument is stolen, damaged, or destroyed; 5) that I will pay all fees necessary for any legal restitution of the instrument or the collection of monies past due; 6) that if I dispute any valid transaction from Rockin’ Robbie’s, Inc. with my financial institution, I will be charged a fee of $50.00, only after Rockin’ Robbie’s, Inc. is determined by my financial institution to be in the right.


1. Rockin’ Robbie’s, Inc. has a professional repair technician on site. If damages or any technical malfunctions occur, it is understood that the instrument is to be brought to Rockin’ Robbie’s, Inc. by the renter. Rockin’ Robbie’s, Inc. covers the cost of general maintenance and normal wear and tear. The renter is responsible for damages resulting from impact, neglect or improper use of the instrument. 2. To ensure quality, all instruments must go through Rockin' Robbie's authorized repair shops. No other Repair facility is authorized to repair our instruments. Please inquire for further details. If the Rockin’ Robbie’s, Inc. staff or the repair technician determines that a charge is necessary, Rockin’ Robbie’s, Inc. will contact the renter to collect payment. Please note that due to the extraordinary volume of instruments returned during certain seasons, it can take up to several months for us to examine the instrument and contact the renter.