VIR Accessory Collection

2015 VIR Affiliate Accessory Collection
Use the secure online form below to place your order for instrument care kits,
indoor/outdoor vinyl banners, imprinted student music folios, and teacher planning wall calendars.
Please contact Dawson Flinchbaugh at 877-727-2798 Ext 10 or email with questions and/or needs.

Affiliate Number	Store Name	Email Address

	Clarinet Care Kit	$6 each ($5.50 pre-paid) plus separate shipping
	Flute Care Kit	$6 each ($5.50 pre-paid) plus separate shipping
	Trumpet Care Kit	$6 each ($5.50 pre-paid) plus separate shipping
	Trombone Care Kit	$6 each ($5.50 pre-paid) plus separate shipping
	Alto Saxophone Care Kit	$6 each ($5.50 pre-paid) plus separate shipping
	Indoor/Outdoor Vinyl Banners	$35 each with FREE shipping
	Imprinted Music Folders	$.45 each ($.35 pre-paid) plus $25 flat shipping
	Educator Planning Wall Calendar	FREE with FREE shipping
	Set of 4 Rental Program Posters	FREE with FREE shipping

Payment Information
Pre-pay below for your order via credit/debit card to take advantage of the offered discount.
Otherwise, leave the payment information boxes blank, and if your account is in good standing,
we'll deduct your invoice from your SEPTEMBER 2015 commission statement (October check).

Debit or Credit Card Type

Credit Card Number (Please DO NOT include spaces, commas or hyphens)

Month & Year Card Expiration Date

Special Notes & Instructions

Veritas Instrument Rental is a proud member of the VH1 Save the Music Foundation,
The National Association of Professional Band Instrument Repair Technicians, The National Association of School Music Dealers
and The National Association of Music Merchants