Synch Licence Request


Synchronization License Request

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PLEASE READ
Priority will be given to those forms that are easily legible and entirely filled in.

Date of Request_________________Your Email_______________________________________________
 
Your Name_________________________________Company Name_____________________________
 
Address______________________________________________________________________________
 
City_________________________________________State________Zip Code ____________________
 
Phone #_______________________________________Fax #___________________________________
 
Type of Request (check box) Motion Picture G Film Festival G TV G
 
Video/DVD G Commercial AdvertisingG Other_____________________________
 
Production Title__________________________________________________________________
 
Brief Synopsis__________________________________________________________________

______________________________________________________________________________
 
______________________________________________________________________________
 
_____________________________________________________________________________
 
Please use additional paper if synopsis is longer than this
 
Song Title____________________________________________________________________________
 
Writer(s)_____________________________________________________________________________
 
Publisher(s)________________________________________________________
 
________________________________________________________________

Master / Re-recording / Cover Artist (Circle One) Artist______________________________________
 
Type of Use (check one)
_____   Background Vocal 
 
______  Background Instrumental

______  Visual Vocal
 
______  Visual Instrumental
 
______ Other__________________________
 
Number of Uses___________Duration of Use(s)________________________________________
 
Territory____________________________
 
Term____________________
 
Media_________________________
 
Scene Description of Use__________________________________________________________
 
________________________________________________________
 
Proposed Fee $_______________
 
Genre (Comedy, Drama, etc.)_________________________Budget________________________
 
Production Company  _____________________________________________
 
Producer   ______________________________
 
Writer      _____________________________
 

Director   ________________________
 
Main Cast Members_______________________________Release Date___________________
 

 
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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