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Music Licensing Form
Artist*
Commencement*
Song Title*
Extract*
Master Source (If Known)
Scene Synopsis*
Title of Production*
Project Synopsis*
Name of Distributor*
Options*
Name of Production Company*
Who is the Publisher(s)?*
Territory*
Terms*
Email Address*
Number of units:
Type of Media
TV (Free to Air)
Yes
No
TV (Pay)
Yes
No
Radio
Yes
No
Internet (All)
Yes
No
Internet (Product Website only)
Yes
No
Cinema
Yes
No
DVD
Yes
No
Film Festivals
Yes
No
Other
Yes
No
Other Value:
Upload Storyboard or Script *
Is it approved?
Your Name*
ABN/ACN*
Phone Number*
Fax Number*
Submit
