Please fill out this form completely to expedite your request. Required fields are red with an asterisk (*). Our address: 2214 Electric Rd., Roanoke VA 24018. Questions? Call us at 540.772.7722.

PLEASE NOTE: We could be at your child's school as soon as the next day! After you've submitted this form, please print the 'thank you' page and place it in your child's instrument case to leave with the Band Director.
Instrument Information
* Instrument Type 
Other Instrument Type 
* Instrument Make 
Other Instrument Make 
Instrument Model 
Instrument Serial No. 
* School 
* Reported Problem 
(Please describe as 
best as you can) 
Customer Information
* Child's Name 
* Customer Name 
Account Number  (if applicable)
* Address 
(Your physical address ONLY, please. No PO boxes.)
* City 
* State   
* Zip Code 
* Phone (Daytime)  (xxx-xxx-xxxx)
Alternate Phone  (xxx-xxx-xxxx)
* E-Mail