Print License Request Form

Print License Request Form
Company Name *
Company Street address *
Street address line 2
City *
State *
Zip code *
Contact Phone number *
Contact Email address *
Contracting Party & Address (if different from Licensee)
Song Title *
Writer(s) / Publisher(s) *
Project Title *
Term *
Territory *
Release Date *

Month Day Year
Date
Other Songs in Project *
Retail Price *
Project Number/UPC/ISBN *
Media *
Royalty Rate *
Number of Units Manufactured *
Advance based on Manufactured *
Digital Release?

Yes
Estimated Digital Sales
Additional Notes/Comments:
If lyric reprint use, please attach the excerpt as it is to appear in your publication, including one page before and after the excerpt.

Select File

Cancel of
Please remit online by pressing the "submit" button or Print and return by fax 615-386-3113 or email jennifer@wordsandmusicadmin.com. For questions please call 615-386-3102.
Should be Empty: