Coleman Page LICENSING Request Form

Coleman Page LICENSING Request Form
Licensor Information

(file upload is available below)
Presenting Organization*
Name of Performers or Performance Organization*
Presenting Organization Point of Contact (First and Last Name)*
Email Address*
Phone Number
Presenting Organization Address

Street Address

Street Address Line 2

CityState

Zip CodeCountry
Musical Work(s) requested for Licensing*
Duration of Usage of Musical Work (e.g. in full, 30 seconds, etc.)*
Nature of Usage (e.g. featured work, background, end title)
Territory to be Licensed (e.g. US Only, the World)
Duration of License (e.g. life of copyright, 5 years, 1 year, etc..)
Number of Performances of Musical Work
Airdate(s) of Production/Performance
Performance Venue(s) and or setup:
Usage Type (mark all boxes that apply)

One-Time Live Performance for Broadcast, Telecast, StreamingContinual Broadcast, Telecast, Streaming VOD, Video GameFilm/Motion PictureAdverstisementMusical Work with Choreography (GRAND RIGHTS) - If selected, please continue to complete this form, including the Grand Rights info at the bottom of this page.Commercial Recording for DistributionEducational/Outreach ProductionOther (please specify in Other Comments)
Please list all streaming web site and stations:
Please describe the nature of use of the Musical Work:
If applicable, please give brief description of overall project and story, and of scene(s) containing Musical Work (continue in Other Comments if need be):
What is the revenue model for your organization and if applicable, of event of requested work (subscription, ad-driven content, etc.?)?
Please list any other music to be played adjacent to requested works.
For GRAND RIGHTS ONLY

PLEASE ENTER Venue Name, Seating Capacity, Avg Ticket Price and # of Performances below. If more space is needed, please use the Other Comments, Long Text fields or file uploader.
Venue Name:
Seating Capacity: blank
Average Ticket Price:
Number of Performances:
Other Comments:
File Upload (optional)

Cancelof
Once submitted, you will be contacted with any questions and/or a quote within the next few days. Thank you!
Should be Empty:

Coleman Page LICENSING Request Form

Licensor Information

For GRAND RIGHTS ONLY