Mechanical and/or Digital Download License Request Form

Licensee (Company/Person Releasing Product)*

Licensee Street address*

Street address line 2

City*

State

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*

Date

Territory of Release*

MECHANICAL LICENSE (required if releasing the project on CD, Vinyl, etc.)*

yesno

Physical Units Manufactured (1,000 unit minimum)*

UPC/ISBN/Product Number*

DIGITAL PERMANENT DOWNLOAD (DPD) LICENSE (required if releasing as digital download)*

yesno

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.