Name

Company Name

Email Address

Telephone

Project Title

Title/s

Composer/s

Duration of song/s

Medium Rights (Please select) Medium Rights (Please select)Advertising (TV/Cinema/Radio/Public Location/Online)Print: Details of the book/selling at, no. of copies / Publication date etc.Feature Film/Documentary: Extent of rights required (TV/Theatrical/Film Festival/Trailers/Website)

Term Required (Please select) Term Required (Please select)Advertising - 3 months / 6 months / 12 monthsPrint – number of prints over a period of timeDocumentaries - Limit of 3 broadcasts per purchasing territory over a 5 year periodFilms - To be specified by client

Usage (Please select) Usage (Please select)Re-recordoriginal recording (if yes, recording rights needs to be cleared additionally and separately with the relevant record label)

Territory

Script / Synopsis Description

Additional Information