Sample/ Sync Request

Licensee Contact Information
Title of your project*
Production Company*
Company/Network name
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone Number*
Email*
Song Information
Song Title*
Artist(s)*
Composer(s)*
Publisher(s)
Source Album
Terms of Request
License Fee
(for 100% of the composition)
MFN
with co-publishers and master owner?
- Yes
- No
Advance
*indicate unit of currency.
Length of Term
(years, months, days)
Date
Territory
please be specific
Projected Sales
(in units)
Synchronization Use Description
Title of your project*
Usage Type*
check all that apply
- In-context
- Out-of-context
- Opening Credits
- Featured
- Background
- Closing Credits
Rights Requested*
check all that apply
- Film
- Television
- Home Video/DVD/Blu-Ray
- Web/Online
- Download
- Streaming/Video-On-Demand
Length of Use
Runtime in minutes and seconds
Brief Information
Please provide a brief synopsis of your project
Brief Description
Please provide a description of the use
Production's total budget
*indicate unit of currency

Licensee Contact Information