CONRAD MUSIC - Surveys

Repair Questionnaire

Please answer the following questionnaire then press 'Submit'.

We are sorry you are having trouble with your instrument, but we are looking forward to getting you back playing again.

Please fill out the following repair questionnaire so we may better provide you a repair cost estimate and care for your instrument. If this is an emergency, please call now at 800-264-3408 for an immediate response.

* required

*1) Parent Name

(30 characters max)

*2) Acct. #

(20 characters max)

*3) Student Name

(30 characters max)

*4) Instrument

(20 characters max)

*5) School

(50 characters max)

*6) Email Address

(30 characters max)

*7) Daytime Phone

(20 characters max)

*8) Is this a Conrad rental instrument?

YESNO

*9) Please describe problem with this instrument.

(1000 characters max)

*10) Will you need a loaner?

YESNO

*11) What is the best way to contact you?

Phone

Either

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