SYNCHRONIZATION COMMERCIAL LICENSE REQUEST
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Advertising Agency or Licensee:
Contact Name:
Address:
Phone Number:
Fax Number:
Email:
Licensee Name:
Product:
Composition:
Writers not performers:
Master recording or re-record:
(if master, list artist)
Background or visual Use?:
background
visual
Visual or Instrumental Use?:
vocal
instrumental
Timing of Song Use:
Timing of Commercial:
Media:
i.e. TV, Radio, Internet, etc.
Territory:
Term:
Start Date:
Number of spots/lifts specify media:
Script/Storyboard:
Options:
Exclusivity?
Yes
No
Explain:
Parody Lyrics:
Production/Music Budget:
Comments:
