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Secure Online Affiliate Application

The Basics: Tell Us About Your Store

Legal Business Name

DBA Name

Business Physical Address

Business City

Business State

Business Zip Code

County Your Business is Located (Not Country!)

Sales Tax Rate (%)

Business Owner Name

Business Owner's Social Security Number
Note: You may substitute Date of Birth

Owner's Home Address

Home City

Home State

Home Zip Code

Business Phone (Include Area Code)

Business Fax (Include Area Code)

Your Email Address

Experience: Tell Us About Your Current Offerings

Are you currently renting band & orchestra instruments?

If Yes, how many instruments did you rent during the last "back-to-school" season?

Are you currently working as a satellite for another rental program provider?

If Yes, with whom are you currently affiliated with?

Are you currently engaging the music educators in your area?

If Yes, in what capacity?

If No, are you willing to cultivate the relationship that is essential to the success of this program?

Observations: Tell Us About Your School Music Market

Number of band and orchestra programs in your area (total band & orchestra of all grade levels)?

Are music educators hosting rental meetings at the school?

If Yes, are you willing to seek an invites and attend?

Who are your top three competitors?

Any other market observations you'd like to share?

We're Almost Done!

Please select two credit references:

How did you hear about VIR?

Anything else you'd like to tell us?

By submitting this Application, you are authorizing Veritas Instrument Rental
to conduct a business and/or personal credit check: