Yamaha National Training Institute RESERVATION FORM

Music in Education System Order Form

This is not an online order form. To place an order, fill out this form completely,
then print it and fax it to us along with a school Purchase Order.

All fields are required and a PO must accompany this document in order for your purchase to be processed.

Once complete, please fax this form and PO to: 1-714-522-9833

Date:

Ship To: Ship To
Phone Number of shipping location: Fax Number of shipping location:

PO#
Bill To: Bill To:
Phone Number of billing location: Fax Number of billing location:

Purchasing Authority Signature:

QTY

PART NUMBER - DESCRIPTION - PRICE EACH

Extended

Shipping & Handling:

Teacher Training

(Value $1,500)

Included in the price of every MIE full or half system is one teacher to be trained at the Yamaha National Training Institute in Buena Park, CA. Please click here for the reservation form.

Subtotal

Sales Tax (if applicable)

Grand Total

Please continue below. All fields are required.

Ship:

Immediately
On:

School(s) where MIE will be installed: (Please provide address and phone number.)	Teacher to be trained: (Please provide home address, phone and email.)

Phone Number of MIE School:	Phone Number of Teacher to be trained:
Fax Number of MIE School:	Email Address of Teacher to be Trained:
For multiple purchases in one school system, provide separate school addresses and phone numbers on another sheet of paper.	For multiple teachers in one school system, provide separate addresses on another sheet of paper.

Office Use Only: Order #___________________ Date entered__________ DSR Initials______
MIE Rep_______________MSC Rep______________ County_______________ Trade Area_______ Approved___________
Please print this form once you have completed all fields. Terms: Payment due within 30 days of invoice date.