MPCA

MECHANICAL LICENSE

REQUEST FORM

SONG TITLE:                               ________________________________________________________


ARTIST TO RECORD:               ___________________________________


LABEL:                                          ___________________________________ (Major? Indy? Self-Promo?)


ALBUM TITLE:                            ________________________________________________________


TYPE OF ALBUM:                       ___________________________________ (Single Artist? Compilation?)


USAGE:                                         __________________________  (Sample? Parody? Standard Recording?)


FORMAT(S):                                __________________________  (CD? Digital Download? AudioStream?)


LENGTH OF TRACK:                 ______________________  (Minutes / Seconds)


TERRITORY:                               ______________________  (Worldwide? US Only?)



RELEASE DATE:                           ______________________  (Month, Day, Year)


UNITS PRODUCED:                 ______________________


METHOD OF SALE:                    ______________________ (Retail? Online? Self-distribution?)


WHOLESALE PRICE:                  ______________________


RETAIL PRICE:                            ______________________


ROYALTY RATE:                         ______________________ (Rate you're requesting? Full stat?)


PURPOSE:                                   __________________________ (For sale? Premium? Promo only?)


LICENSEE:                                    ____________________________________________________


   (Name, Company)                   ____________________________________________________


                                                        ____________________________________________________



   (Address)                                   ____________________________________________________


                                                        ____________________________________________________


   (Phone)                                      ___________________________


   (Fax)                                            ___________________________


   (E-mail)                                       ___________________________


Options requested:  _____________________________________________________


                                ________________________________________________________


Exclusivity?                     YES ____  NO ____

Parody lyrics?                 YES ____  NO ____


If yes, please attach new lyrics to your request if currently available.

Production/Music budget:  _________________________


Comments:


 ________________________________________________________________________


 ________________________________________________________________________


 ________________________________________________________________________


 ________________________________________________________________________


 ________________________________________________________________________


 ________________________________________________________________________

 

Thank you for our interest in this MPCA Song.

Please complete this form and fax it, along with any additional elements

(i.e. film synopsis, parody lyrics)

to the following number:

MPCA FAX:

(212) 796-2031

We will be in touch with you.

MUSIC PUBLISHING COMPANY OF AMERICA ­ IT ALL STARTS WITH A SONG.