Licensing/Clearance

Type of License Please Select One Advertisement Feature Film/Documentary (Theatrical) Feature Film/Documentary (Non-Theatrical) Film Festival Trailer/Promo TV Show Industrial In-House Internet/Web Use Live Performance Game Non-Commercial Use (Wedding Videographers) Video/DVD (Corporate Video) Video/DVD (for Retail) Educational Non-Profit Background Music for Establishments Other (please provide info in Additional Comments)

First Name

Last Name

Your role

Email

Telephone

Project Name

Production Company/End Client

Cast

Synopsis

Producer/Director

Production Budget/Music Budget

Distribution/Territory

Track Name/Version/Artist

Timing of Use/Scene Description

Number of Uses/Length of Uses

Type of Uses Please Select One Featured Vocal Featured Instrumental Background Instrumental Background Vocal Visual Vocal (on-camera performance - actor) Visual Vocal (on-camera performance - artist) Visual Instrumental (on-camera performance - actor) Visual Instrumental (on-camera performance - artist) Mood Music

Requested Media Rights Please Select One Broad Rights Theatrical Rights Only Television Only Video/DVD Buyout Festival Rights Only Internet Only Game Only In-Context Advertising Out-of-Context Advertising

Requested Licensing Fee for Sync

Requested Licensing Fee for Master

Is this Fee on a Favored Nations basis with all songs licensed? Please Select One Yes No

Type of Credits Granted Please Select One End Credit Roll Cyron Box Cover/Packaging Website Link Other (please provide info in Additional Comments)

Quote Request Deadline

Additional Comments