Mechanical and/or Digital Download
License Request Form
Licensee (Company/Person Releasing Product)
*
Licensee Street address
*
Street address line 2
City
*
State
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Zip code
Contact Phone number
*
Contact Email address
*
Record Label (if different from Licensee)
Artist
*
Project Title
*
Song Title
*
Writer(s)/Publisher(s)
*
Song Duration (minutes : seconds)
Release Date
*
-
Month
-
Day
Year
Date
Territory of Release
*
MECHANICAL LICENSE (required if releasing the project on CD, Vinyl, etc.)
*
yes
no
Physical Units Manufactured (1,000 unit minimum)
*
UPC/ISBN/Product Number
*
DIGITAL PERMANENT DOWNLOAD (DPD) LICENSE (required if releasing as digital download)
*
yes
no
Downloads Anticipated (1,000 unit minimum)
*
ISRC Code
*
Additional Notes/Comments:
Please remit online by pressing the "submit" button or Print and return by fax 615-386-3113 or email licensing@wordsandmusicadmin.com. For questions please call 615-386-3102.
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