Licensee Information:

1. Address Change     Never Licensed

    

2. Name/ Organization:



 

3. Attention:



 

4. Address:



 

5. City:



 

6. State:



 

7. Zip:



 

8. Telephone Number:

 

9. Fax Number:

 

10. E-mail Address:



 

11. Briefly describe your organization and give any information you feel might be helpful to us as we consider your request:



 

Song Information:

1. Song Title:



 

2. Author(s):



 

3. Publisher:



 

4. Copyright Year:



 

5. Recorded Length of Song:



 

6. Please indicate if the song is used more than one time in the program:



 

Product Information:
(To issue a license we must have all the applicable information about your project listed below.)

1. Title:



 

2. Format:

Video
TV
Radio
Live Performance
Other   (specify:)

 

3. Product Number or Program Number:



 

4. Release Date or Date of First Broadcast:



 

5. Initial Number of Units Manufactured:



 

6. Type of Use:

Featured
Vocal
Instrumental
Background

 

7. Territory:



 

8. Production Company or Producer:



 

9. Approximate Production Budget:



 

10. Length of Program:



 

11. Number of songs in the program:



 

12. Total length of all music in program:



 

13. Target audience:



 

14. Approximate size of audience:

 

15. Term requested (No. of years):

 

16. Description/nature/purpose of program:



 

17. Description of context/scene which uses the song:



 

Additional Information For TV/ Radio Request:

1. Requesting use of song as theme of program?  
Yes No

 

2. Broadcast delivery system(s): (network name, local cable, public access, etc...)



 

3. Number of stations:

 

4. Total Number of Broadcasts:

Number of Weekly Broadcasts:
Number of Daily Broadcasts:

 

Additional Information For Video Request:

1. Suggested retail selling price:



 

2. Suggested Donation:



 

Additional Information For Live Performance Request:

1. Ticket price(s):



 

2. Suggested Donation:



 

3. Number of Performances:



 

4. Number of seats (approximate number of tickets to be sold per performance):



 

Master Recording Information:

1. Using actual Two Wings Music sound recording?  
Yes No

 

2. If yes, please complete the following information:

Title:


Two Wings Music Album Title:


Product Number:


Number of Times Recording is Used in Project:



 
Check here to receive approximate licensing fee information from Contract Administration.

Credits: In order to help us to give credit where credit may be due, please tell us how you came to know of us.

CW-PN Radio (ChristWorld-PraiseNation Radio) Internet Search Friend Music Store Other - How Did You Hear About Us? -

If other, please specify.

Thank you.