store – Little Jammerz

Rent Or Buy Instrument

Please fill out the form and pay below to buy an instrument

Purchase Instrument*
- $20 Guitar Rental
- $35 Purchase Ukulele
Student Name*
First Last
Name of Elementary School*
Grade*
Parent Name #1*
First Last
Parent #1 Cell Phone*
Parent #1 Home/Work Phone
Parent #1 Email*
Parent Name #2 (optional)
First Last
Parent #2 Phone (optional)
Parent #2 Email (optional)
Billing Address*
Street Address Address Line 2 City Province Postal Code
Total
$ 0.00 CAD
Credit Card*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name