Would you like to use a song from the Last Gang catalogue?
Please fill out this synch license request form.
(
*
indicates required field.)
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GENERAL INFORMATION:
*
Contact Name:
*
Name of Production Company:
*
Phone:
*
Address:
*
Fax:
*
City:
*
Email:
*
State/Province:
*
Website:
*
Postal Code:
Where did you discover the band's music?
Comments:
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REQUESTED MUSIC:
*
Title:
*
Artist:
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PRODUCTION DETAILS:
*
Please select one:
Motion Picture
Student Film
Commercial
TV Series
Other
*
Title:
*
If you've selected "OTHER", please specify:
*
Synopsis (600 words):
*
Description of scene in which song will be used:
*
Producer(s):
*
Cast Member(s):
*
Length:
*
Release Date / Air Date:
*
Anticipated total production budget:
*
Proposed fee:
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TERRITORY:
*
For which territory are you requesting this license:
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TERM:
*
In perpetuity?
YES
NO
>> Please indicate the
#
of years, and the
#
of months.
*
Debut Date:
*
End Date:
*
Usage:
Theatre
Satellite TV
DVD rental-home use
Free TV
Airline
Educational
Cable TV
Film Festival
Other
Pay TV
DVD for sales-home use
Select/Unselect all
*
If you've selected "OTHER", please specify:
Thanks for your time, we will get back to you within the next 72 hours.