Electronic

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

Cell Phone *

Phone *

E-mail *

Is the piano in a different location?

It may take from two days to two weeks to arrange the adoption of your instrument.

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

If a Spinet or Upright that has legs, photograph left leg.

Brand name of Piano (if available)

Date requirement for moving the piano

Address *

Year of manufacture - if available

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

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

If a Spinet or Upright that has legs, photograph right leg.

Name *

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

Date

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

City, State, Zip *