CUSTOM MECHANICAL LICENSE REQUEST

Name

First Name

Last Name

Company Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email Address

Title Of Song

Writers (If Known)

Title Of Release

Artist

Date Of Release

YYYY

Record Label

Playing Time (min. and seconds only)

Indicate minutes and seconds only. Place 2 zeros in the hour field and just ignore the AM/PM field.

Hour

Minute

Second

Product Configuration

Physical CDS

Digital

Number Of Physical Product Manufactured (See Below)

UPC Codes (if known)

Number Of Digital

Track ISRC (if being released digitally)

Message

+ If you get a license for physical copies this does not give you the right to offer downloads on any website, including iTunes. You must request a digital license and pre-pay for the number of downloads you think you might sell (minimum of 100). After that, you should keep track of the number of downloads sold and when the amount you paid for is met, you can request a new license from us. All licensing fees are at statutory rate (currently $.091 or $.0175 per minute of playing time, whichever is greater) per composition per unit or download.