SYNCHRONIZATION TELEVISION 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:
Type of Production:
Synopsis:
Scene Description:
Background or Visual Use?:
background
visual
Vocal or Instrumental Use?:
vocal
instrumental
Notable actors, directors:
Timing of Song Use:
Media:
i.e. TV, Video, etc.
On what station will production initially air?:
At what time will production initially air?:
Territory:
where the product will be sold, i.e. US or Worldwide
Term:
Start Date:
Options:
Parody Lyrics:
Production/Music Budget:
Comments:
