Licensing Request Form
Contact Info
Name:
Company Name:
Address:
City: State: Zip:
Phone:
Email:  
Song Selection
Which song(s) would you like to license? (Unsure? Describe the mood and we'll make suggestions.)
Project Description
Please provide a brief description of how the music will be used:
Duplication/Reproduction/Sales
1. Will you be duplicating the final product?   Yes No
    1a. If so, how many copies will be duplicated?
2. Will the final product be available for sale?   Yes No
    2a. If 'yes', please specify the product's retail cost:
3. Please specify your market distribution:     Regional     National     World
Your Organization
Have you ever done business with The O'Neill Brothers or the Harry Fox Agency? Yes No
Which category best describes your organization?
Please state your organization's approximate annual gross receipts: