Production Company/Network name
Contact Name*
(your name)
Street Address*
City*
State*
Zip Code*
Country*
Email Address*
Phone Number * (555-555-5555)
Fax Number
Song Title*
Artist(s)*
Composer(s)*
Publisher(s)
Source Album
License Fee*
(for 100% of the composition)
Length of Term (years, months, days)
Release Date
Territory
Projected Sales
(in units)
Title of project
Usage Type
(check all that apply)
In-content
Out of Content
Background
Rights Requested*
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Streaming/Video-On Demand
Television
# of Tracks on Album/Compilation
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