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FILM / SYNCHRONIZATION / VIDEOGRAM LICENSING INFORMATION FORM
For: SONGS FOR THE PLANET, INC.

Date 
Name of Licensee 
Street 
City 
State 
Zip 
Contact Name for Licensee 
Email address 


THE FOLLOWING INFORMATION IS REQUIRED FOR PROMPT AND ACCURATE LICENSE ISSUANCE:

Name of Composition(s)
Publisher(s) and Percentage(s) controlled/owned%
Owner of product to be manufactured (individual, company, or entity)
Who will pay royalties to owner of master?
Retail Price
Royalty rate or percentage requested by licensee
Royalty rate to be paid per videogram
Term of license requested
Advance fee (if applicable)
Fixing fee (if applicable)
Project Name
Product number(s)
Number and type of units to be manufactured: 
Visual Vocal 
Full Feature Performance 
Background Vocal 
Other (specify) 
Release date or manufacturing date
Is this license for use only in the United State of America? YES NO
If no, please indicate countries or territories to be covered
Indicate method of sale (i.e. retail, mail order, direct, etc.)

The proper copyright notice for our portion of the copyright shall be sent along with the license upon the receiving of this completed form and the approval of the requested use by the clients(s) we represent.

Please obtain all the respective publishing licensees from the respective owners of the composition(s) embodied in recording(s).

IT IS THE RESPONSIBILITY OF THE LICENSEE TO MAKE SURE THE PROPER COPYRIGHT NOTICE AS GIVEN BY LICENSOR OF MASTER AS WELL AS THE PERFORMER AND PRODUCER FOR EACH MASTER USED IS ON EVERY UNIT MANUFACTURED AND/OR DISTRIBUTED.