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? Y/N Yes No
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? Y/N Yes No
If Yes, with whom are you currently affiliated with?
Are you currently engaging the music educators in your area? Y/N Yes No
If Yes, in what capacity?
If No, are you willing to cultivate the relationship that is essential to the success of this program? Y/N Yes No
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? Y/N Yes No
If Yes, are you willing to seek an invites and attend? Y/N Yes No
Who are your top three competitors?
Any other market observations you'd like to share?
We're Almost Done!
Please select two credit references: Reference One Fender Roland Yamaha St. Louis Music Midco Kaman Harris-Teller GE Textron Reference One Fender Roland Yamaha St. Louis Music Midco Kaman Harris-Teller GE Textron
How did you hear about VIR? Select One NAMM Show Rep Referral Trade Magazine Ad Internet Search Affiliate Referral Other
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: