Register

1
Full Name* This field is required.
First Name
Last Name
2
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Phone Number* This field is required.
Area Code
Phone Number
4
E-mail* This field is required.
5
Birth Date* This field is required.Please enter your date of birth
Month
Day
Year
6
Name of Performing Artist
7
Approximate Number of StreamsEnter the number of streams/plays on Apple Music or Spotify
8
Please select one
Songwriter
Producer
Songwriter & Producer
Label
9
PRO AffiliationSelect the Performance Rights Organization that you are currently affiliated with
ASCAP
BMI
SESAC
Other
None
10
Author/Composer CAE/IPI NumberIf you have been issued a Author/Composer CAE/IPI number please enter it below
11
Name of Publishing Company?
Select "Next" if you do not have a Publishing Company.
12
Publisher CAE/IPI NumberIf you have been issued a Publisher CAE/IPI number please enter it below
Select "Next" if you do not have a Publisher CAE/IPI number..
13
Payment Information* This field is required.
Individual/Sole Proprietor
Individual/Sole Proprietor
Single-Member LLC
C Corporation
S Corporation
Partnership
Limited Liability Company
Trust/State
W-8BEN
Select one of the following
14
Name on Tax Return* This field is required.
Legal Name of Tax Return
15
Social Security/EIN* This field is required.Please enter your Social Security Number or Tax ID
16
We need a valid form of photo identification to verify your identity* This field is required.This information is required for payment purposes and the prevention of fraud. Please provide a copy of your government-issued photo ID (driver's license, passport, etc.)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
17
Authorization* This field is required.
I authorize Digital Royalty Distribution LLC to have online account access to my ASCAP, BMI, & SESAC publishing accounts for the following: Live Works Registration, Works Catalog, and Royalty Statements.
18
Authorization* This field is required.
I authorize Digital Royalty Distribution LLC to register song titles, submit claims, disputes, resolve discrepancies, issue licensing agreements, administer the collection & royalty payments on behalf of my publishing designee from all Digital Service Providers (DSP), Performance Rights Organizations (PRO), Mechanical Licensing Collectives (MLC) and all other licensing parties.
19
Authorization* This field is required.
I certify that: The payee's SSN/TIN is correct, the payee is not subject to backup withholding due to failure to report interest and dividend income and the FATCA code entered on this form (if any) indicating that the payee is exempt from FATCA reporting is correct.
20
Terms and Conditions* This field is required.
21
Signature* This field is required.
Powered by Jotform SignClear
22
Tags
Todo
In Progress
Done
Should be Empty: