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*

MonthDayYear
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.

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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.
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