| Date |
|
| Name of Licensee |
|
| Street |
|
| City |
|
| State |
|
| Zip |
|
| Contact Name for Licensee |
|
| Email address |
|
| Name of Artist(s) performing on Master |
|
THE FOLLOWING INFORMATION IS REQUIRED FOR PROMPT AND ACCURATE LICENSE ISSUANCE:
|
| Name of Master Recording (one per form) |
|
| Percentage(s) controlled/owned by the Owner of Master |
% |
| Owner of product to be manufactured (individual, company, or entity) |
|
| Who will pay master royalties to owner of master? |
|
| Retail Price |
|
| Number of non-P.D. masters on project |
|
| Term of license requested |
|
| Advance fee (if applicable) |
|
| Royalty rate or percentage requested by licensee |
|
| Producer(s) and or Arranger(s) name |
|
| Title of project |
|
| Product number(s) |
|
| Number and type of units to be manufactured: |
|
| CD |
|
| Cassette |
|
| Vinyl LP |
|
| CD Single |
|
| Video |
|
| Other (specify) |
|
| Release date or manufacturing date |
|
| Will owner-provided artwork be printed on product? |
YES NO |
| Is this license for use only in the United State of America? |
YES NO |
| If no, please indicate countries or territories to be covered |
|
| Indicate method of sale (i.e. retail, mail order, direct, etc.) |
|
