Owner's Name First Name Last Name Piano Make Model Note or Section Bass Section Treble Section Bass & Treble Sections A A# B C C# D D# E F F# G G# Note # 0 1 2 3 4 5 6 7 8 Key Capstan(s) Key Button(s) Front Rail Bushing(s) Front Rail Pin(s) Front Rail Punching(s) Balance Rail Bushing(s) Balance Rail Pin(s) Balance Rail Punching(s) Key Front(s) Key Tail(s) Key Top(s) Key Stick(s) Condition Broken Corroded Loose Missing Oxidized Repair Required Rusted Split/Cracked Stripped Tarnished Worn String Steel Core Copper Coil Tuning Pin Tuning Pin Bushing Tuning Pin Coil Tuning Pin Becket String Becket Condition Broken Corroded Loose Missing Oxidized Repair Required Rusted Split/Cracked Stripped Tarnished Worn Whippen Jack(s) Jack Tender / Toe(s) Repetition Lever(s) Repetition Lever Spring(s) Drop Screw(s) Jack Flange(s) Jack Flange Pin(s) Jack Flange Bushing(s) Repetition Lever Window(s) Repetition Lever Button Screw(s) Repetition Lever Flange(s) Repetition Lever Flange Screw(s) Thank you!
