First Name *
Last Name *
Company Name (if any)
Email *
Phone *
Song Title, Artist, Track Title * (if instrumental)
Ex: This Town, Mike Craftsman, Gaunlet Mafia
Project Type * (TV Show, Film, Trailer, Promo, Advertisement, etc.)
Project Name * (Scene Description & Nature of Use)
Ex: Breaking Bad, Walt scrambles to hide evidence, Background Instrumental
Media Rights * (TV, Internet, Radio, etc.)
Length of Song / Track Used *
Term Length * Territory * Estimated Budget *
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