Song Title

Songwriter

Artist Name

Album Title (if applicable)

Recording (if diff. from title)

ISRC Number

Record Label

Distributor (if known/applicable)

Length of Recording (UNDER FIVE MINUTES 5:00)

Number of Units Licensed (BETWEEN 1,000 and 10,000)

Licensee Name

Licensee Email

Licensee E-Signature

Licensee Title