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    First Name *

    Company Name (if any)

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    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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