Repair & Recycling Reimbursement Form
Use the form below to request reimbursement for approved repair & recycling services performed. Orders are parsed & emailed directly to our service Center Director at the VIR Feathersound Facility.
To inquire about the status of a reimbursement, please contact Stephen Hollenbeck at stephenh@veritasrental.com or call 877-727-2798 Ext 20.


Affiliate Number
Store Name
Email Address
Service Type*
*Itemize Repairs only or Recycling only. Please do not mingle both on the same form. Submit additional forms, if necessary.
Repair Date
Repair Ticket Number
Customer Account Number
Customer Last Name
Instrument Type
Serial Number
Brief Description of Service Performed
Loaner SN
(if provided)
Price to VIR

Technician Name
Make Check Payable To
Total Due
Additional Notes, Requests or Message to VIR Service Center Coordinator

IMPORTANT: READ CAREFULLY BEFORE SUBMITTING THIS FORM
Service professionals must be authorized to work on VIR-owned instruments and agree to the terms & pricing outlined in our M&R Reimbursement & Recycling Schedules before any work is performed. CLICK HERE for a current PDF version of our schedules. Reimbursement requests exceeding the current pricing schedule will automatically be adjusted. Any single repair exceeding $30.00 requires prior authorization from VIR.


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

©2014 Veritas Instrument Rental Incorporated