Picture of keyboard with name-plate (above middle C ) *

Recipients will pay for moving costs. Movers will need to know how many stairs from the piano to the curb. *

List general condition and any problems with the piano such as sticky keys, dropped pedal, etc. If no problems exist type "none". *

Cell Phone *

Phone *

Grand Piano

NOTE Piano will not be considered without pictures.

My piano may be donated to other than a nonprofit organization. *

I agree

I do not agree (non-profit only)

Address *

Year of manufacture - if available

For Grand: entire piano with lid open, picture 1 of 2 different photos.

Brand name of Piano (if available)

Date requirement for moving the piano

Is the piano in a different location?

E-mail *

Select piano from drop down list *

City, State, Zip *

Date

Name *

For Grand: entire piano with lid open, picture 2 of 2 different photos.

Piano and Instrument Donation Program in Los Angeles.

All required sections must be filled out or form cannot be submitted.

Having trouble with this form? Contact us at piano@pianoadoptionprogram.org