ONLINE LICENSE APPLICATION & USAGE REPORT

Broadcast Clearance, Tracks & Usage

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BROADCAST CLEARANCE Enter the type and territory of your Broadcast usage.
COMMERCIAL INFOMERCIAL TV PROGRAM PROMO PSA RADIO PROGRAM	TERRITORY Local (Specify city/state) Regional (Specify region) National Worldwide
INTERNET	URL:

BROADCAST MEDIA How will your production be released?

FREE TV RADIO PAY / CABLE TV WWW / Internet ALL TV OTHER

TRACK USAGE Enter disc numbers, track numbers and frequency of use for your selections.

ITEM CD NO. TRACK NO. NO. USES 1. 2. 3.  4.  5.  6.  7.  8.  9.  10.

PRODUCTION BLANKET Do you want a production blanket?

Production blanket rates allow unlimited music use in any single production. See current rate card for definitions. If you do not want a production blanket, please continue to Step Two. Yes: I II III IV No, production blanket not needed.

Production, Billing and Contact Information

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PRODUCTION INFO * Required fields

Title of Production * Purchase Order No. Production Date * Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2006 2007 2008 Length of Production * minutes Ad Agency / Client

If applicable: Initial Air Date Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2006 2007 2008 ------ Air Date Unknown ISCI Code Media Buyer

BILLING CONTACT * Required fields

Attn * E-mail Company * Phone * Fax Address 1 * City * State * Province Address 2 Zip/Postal Code * Country

LICENSING CONTACT * Required fields

Your Name * Company Phone * Fax Address 1 City State Province Address 2 Zip/Postal Code Country

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Questions? Licensing: toll-free (866) 818-4260 Sales: toll-free (888) 757-8633 Fax: toll-free (925) 820-8985	Please check all of your entries again carefully. Then click below to submit your application.