Lisa Hilton Music—Master Recording License/Synchronization License Request Form
Please fill out form and fax to: (310) 457-3250. One song per form.
Production Company/Licensee_______________________________________________
Date:_______ Date Needed:__________Contact Name:___________________________
LicenseeÕs Address:_______________________________________________________
Phone:_______________Fax:_______________E-Mail__________________________
Project Title:_____________________________________________________________
Client/Distributor:_________________________________________________________
Project Description:_______________________________________________________
Song Title:_____________________________________Catalog #: LH-_____________
Writer:____________________________________Length of Song:_________________
Any Changes
# Of Times Song Used in Project:________to original song?:_______________________
Usage: (check applicable):
______Film _____DVD/Video _____TV ____TV Ad ____Radio Ad ____Other
______Background _________Visual _________Opening Credits_______End Credits
Scene Description:________________________________________________________
Territory Used:______US ______World _______US & North America _______Other
Term: Length of Time Valid (Months and Years):________________________________
Music Budget:__________ Total Budget:___________ Budget for this Song:________
Delivery of Music: Format requested:_________________________________________
Address to send to:________________________________________________________
You will be
contacted by Lisa Hilton Music regarding the license and budget
approval, and e-mailed a secure credit card payment form for Mastercard/Visa.
Thank You !