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MPCA MERCHANDISE SYNCHRONIZATION LICENSE REQUEST FORM |
Licensee Name: __________________________________________
Contact Name: __________________________________________
Address: __________________________________________
__________________________________________
Phone Number: (___) _____ - ____________
Fax Number: (___) _____ - ______________
Email: ____________________________________________
SONG TITLE: __________________________________________________
Writers: __________________________________________________
Master recording or re-record?
If Master, list original artist: ___________________________________________
Product Name: _________________________________________________
Type of Product: _________________________________________________
How will the song be used? _________________________________________________
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Type of use: Sound Chip ____ Vocal _____ Instrumental _____ Other ______
If other Please explain: _________________________________________________
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Length of Song to be used: _______________
Territory: _________________________________________________
Term: _________________________________________________
Start Date: _______________
Number of Units Manufactured Initially: _____________________
Retail / Wholesale Price: ______________________________
Options Requested: _________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Parody Lyrics? Yes ____ No _____
If YES, please attach a copy of the new lyrics to your request if currently available.
Production/Music Budget, per piece rate requested: ________________________________
Retail / Wholesale price: _________________________
Comments:
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
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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.