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Briti Black Licensing Request Form
Official licensing form from Haus Blk, LLC
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* Indicates required question
Licensee
*
Your answer
Contact Info
*
Your answer
Requested Property
*
Briti Black Promo Photos
Briti Black Video Clips
Briti Black Full Scenes
Title(s) requested
*
Your answer
Brief description of the clip(s) or still image(s) being requested
*
Your answer
Specific context in which property would be used
*
Your answer
Requested Use
*
Your answer
Project/Program Title:
*
Your answer
Distribution Platform
*
Your answer
Territory / Countries in which production will be distributed
*
Your answer
Initial Release Date
*
MM
/
DD
/
YYYY
Project Deadline
*
MM
/
DD
/
YYYY
Additional Comments
Your answer
I Affirm that the responses to be true and accurate.
I Affirm
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