SYNCHRONIZATION WEBSITE LICENSE REQUEST

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Licensee Name:
Contact Name:
Address:
Phone Number:
Fax Number:
Email:
Composition:
Writers:
not performers
Master recording:
Production Name:
Synopsis:
Scene Description:
Background or Visual Use?: background

visual
Vocal or Instrumental Use?: vocal

instrumental
Timing of Song Use:
Term:
Start Date:
Options:
Website URL:
Where does the site reside?:
Does the site nave a performance license with ASCAP/BMI?: Yes  No
How is the song accessible?:
Is the song downloadable?: Yes  No
Does the site have paid advertising?: Yes  No
Does the site require subscriptions/fee?: Yes  No
Parody Lyrics:
Production/Music Budget:
Comments: