All sections required.

Label Name/Company Releasing the Product

Label Address

Your Name

Contact Email

Contact Telephone

Song Title

Writers

Album Title

Artist

Mechanical Rate

Proposed Advance

Catalog Number/UPC

Track Timing

Configuration(s)

Suggested Retail Price of Album

Track ISRC code

Date of Release

Number of Units being manufactured

Territory

Term

Number of Tracks on Album

List of all Tracks on Album

Your Message

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Company Name/Company Releasing the Product

Company Address

Your Name

Contact Email

Contact Telephone

Type of Request

Production Title

Brief Synopsis

Title of Composition

Songwriter(s)

Master Recording Used

Master Recording Owner

Type of Use

Number of Use(s)

Duration of Use(s)

Scene Description of Use(s)

Total Production Budget

Date of Release

Media Rights Requested

Territory

Term

Proposed Fee

Options

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Song Title

Writers

Licensee Name

Licensee Address

Your Name

Contact Email

Contact Telephone

Production Title

Venue

Language

Number of Shows

Venue Capacity

Ticket Price

Territory

Term

Proposed Fee

List of all other Songs in Production

Your Message

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Company Name

Company Address

Your Name

Contact Email

Contact Telephone

Full Contracting Party

Name & Likeness Property

Date

Product or Production Title

Synopsis

Distribution Channels

Proposed Fee

Description of Use

Total Media Budget

Territory

Term

Comments

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Company Name

Company Address

Your Name

Contact Email

Contact Telephone

Full Contracting Party

Date

Title of Composition

Writer/Composer(s)

Project Title

Units

Media

Territory

Term

Royalty Rate

Retail Price

Proposed Advanced Based on Manufacture

Number of Works in Project

Proposed Fee

Quoted Lyrics

Comments

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Company Name/Company Releasing the Product

Company Address

Your Name

Contact Email

Contact Telephone

Details of the New Work:

Title

Artist

Label/Distributer

Proposed Release Date

Distribution Method

Retail Price

Term

Quantity to be Pressed

Territories of Release

Composers/Authors

Publishers

Details of the Original Work:

Title

Artist (if applicable)

Releasing Label

Composers/Authors

Publishers

Description of sample/adaptation usage

Are any other samples used in this recording? If so please list and give details of clearance.

Contracting Party

Address of Contracting Party