Mechancal License Form


Mechanical License Request

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PLEASE READ
Priority will be given to forms that are easily legible and entirely filled in.
This form is written to make this process easier for you.  So use it
 
Requestor Information

Your Name_______________________________________________ Date of Request______________
 
Phone #___________________________________Fax #_______________________________________
 
Email________________________________________________________________________________
 
Record Label (if applicable)_____________________________________________________________
 
Label Address (if you are not using a Record Label, provide your mailing address)
 
Address______________________________________________________________________________
 
City______________________________________State__________Zip Code_____________________
 
About Your Record
Artist (if compilation do not put “Various”)____________________________________________________
 
Record Title___________________________________________________________________________
 
Record Number__________________Release Date________________Song Playing Time_____________
 
Anticipated Quantity of Units (please circle):
Over 5,000
Under 5,000 (if under please fill out chart)
 
CONFIGURATION QUANTITY
For download requests also provide: CD/DIGITAL DOWNLOAD/VINYL

Digital UPC #_______________________________ DOWNLOAD (please estimate)
 
ISRC #_____________________________________ TOTAL
 
Information About The Song You Wish To Use
Title (s)______________________________________________________________________________

Writer(s)_____________________________________________________________________________
 
Publisher(s)__________________________________________________________________________
 
 
Once this form is complete please Mail to:
 
Cosmic Trigger Inc. 
217 East 86th St  #151
New York, NY 10028
 
Or FAX to : 212 262 6299
 
Please allow 10-14 business days to process your request before following up.




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1202 Lexington Ave #217 
New York, NY 10028
646 438 2690

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