Copyright Request Form

Name *

Phone *

Email *

Are You Shipping Outside the United States? *

Yes

Shipping Address (if Inside the US) *

Shipping Address if Outside the United States *

If billing address is different please check box below.

Different Billing Address

Alternate Billing Address *

Organization *

Composition Title *

Composer / Arranger *

Publisher / Imprint *

Request Type *

Permission Term Start Date *

Permission Term End Date *

Territory (Please specify which Country, Region, or “World” *

Additional Details