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Company Name/Company Releasing the Product
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Your answer
Company Address
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Your answer
Your Name
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Your answer
Contact Email
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Your answer
Contact Telephone
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Your answer
Type of Request
*
TV
Motion Picture
Film Festival
Promo Video
Commercial
Video Game
Other:
Production Title
*
Your answer
Brief Synopsis
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Your answer
Title of Composition you wish to use
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Your answer
Songwriter(s)
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Your answer
Master Recording Used
*
Original Recording
Cover
Other:
Master Recording Owner
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Your answer
Type of Use
*
Background Vocals
Instrumental
Visual Vocal
Main
Other:
Number of Use(s)
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Your answer
Duration of Use(s)
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Your answer
Scene Description of Use(s)
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Your answer
Total Production Budget
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Your answer
Date of Release
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MM
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DD
/
YYYY
Media Rights Requested
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Your answer
Territory
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Term
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Proposed Fee
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Your answer
Options
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Your answer
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