First name

Last name

Company/Affiliation

Email Address

Retype Email Address

Phone Number

Alternate Phone Number

Who will be using the music? Choose One Independent or Student Film Major Motion Picture TV Program Commercial Video game Website Non-profit Other

How will the music be used? Choose One Background Featured Onscreen Vocal Main or End Titles Other

How will the music be distributed? Choose One All Media Online Only All TV Media Film Festival Theatrical Distribution Other

Approximate length of usage Choose One less than 20 seconds 20 seconds - 1 minute 1 - full song

Term Choose One One year Two years Five years In perpetuity Other

Contact me by* email phone

Additional Notes

CANCEL