| 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 Composition (one per form) |
|
| Publisher(s) and Percentage(s) controlled/owned |
% |
| Owner of product to be manufactured (individual, company, or entity) |
|
| Artist(s) Name: |
|
| Title of Recording Project |
|
| Product number(s) |
|
| Number and type of units to be manufactured: |
|
| CD |
|
| Cassette |
|
| Vinyl LP |
|
| CD Single |
|
| Other (specify) |
|
| Release date or manufacturing date |
|
| Recorded Length |
|
| Will lyrics be printed on sleeve or insert? |
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.) |
|
