SYNCHRONIZATION IN-HOUSE LICENSE REQUEST

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Licensee Name:
Contact Name:
Address:
Phone Number:
Fax Number:
Email:
Composition:
Writers:
Master recording
or re-record
if master, list
Artist:
Production Title:
Synopsis:
Scene Description:
Background or Visual Use?: background

visual

Vocal or Instrumental Use?: vocal

instrumental

Timing of Song Use:
Media:
i.e. VHS, CD-ROM, etc.
Territory:
where the product will be sold, i.e. US or Worldwide
Term:
Start Date:
Options:
Number of Units:
Will copies be distributed?: Yes   No
At what price?:
Who will view?:
# of viewers at each presentation:
# of presentations:
Will admission be charged?: Yes   No
How Much?:
Parody Lyrics:
Production/Music Budget:
Comments: