Memory Lane Music Group
Larry Spier Music | Memory Lane Music Group | Scion Music Group
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Online Licensing Request Form
Online Licensing Request Form
Name:
Company:
Phone:
Fax:
E-Mail:
Address 1:
Address 2:
City:
State/Province:
Zip Code:
Country:
Song Title:
Song Writers:
Project Title:
Media:
(Hold CTRL and click
to select multiple items)
Television Commercial
Radio Commercial
Film
Film Festival
Free Television (specify below if necessary)
Cable Television (specify below if necessary)
Satellite Television (includes DBS)
Home Video - DVD/VHS
Grand Rights
Karaoke
Ring Tones
Specialty Product (ie: toys, games, etc.)
Other
If other, please specify:
Type of Usage:
Background Instrumental
Background Vocal
Visual Dance
Visual Instrumental
Visual Vocal
Other
If other, please specify:
Duration of Usage:
Number of Usages:
License Term:
Territories:
Project Synopsis:
Comments:
Licensing - Music Publishing Services