Media Request Form

Media Request Form

Thank you for requesting a service from Name's Blue Media! Please be sure to fill out all required sections so we may capture complete project intelligence, clarify deliverables, define timelines, and align stakeholders before production begins.
Client & Project Identification
Primary Contact

First NameLast NameSuffix
Position & Title
Example: "Executive Director of Organization LLC"
Your Email
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Website of Organization
www.example.com
Project Scope & Objectives
Project Title
Provide a short title for the project
Project Summary
What are the details of the project? Please provide as much information as possible.
Primary Objective
Target Audience
Key Message or Call-to-Action
What are the desired outcomes of this project? What should viewers think, feel, or do? Outcomes should be specific, measurable, achievable, realistic, and time-bound.
Service Request Type
Select the services that apply to your project.
Quantity Of Videos
Quantity Of Photos
Aspect Ratios
File Format
Timeline & Scheduling
Requested Production Date

MonthDayYear
Additional Dates
If there are multiple dates.
Event / Filming Start & End Time

Hour Minutes

AM/PM Option

Until

Hour Minutes

AM/PM Option
Setup Time Required?
Only If Setup Time is Required.

Hour Minutes

AM/PM Option

Until

Hour Minutes

AM/PM Option
Rain Date

MonthDayYear
Requested Delivery Date

MonthDayYear
Hard Deadlines
If there are multiple dates, please provide all dates and times. Grant deadlines, broadcast schedules, premieres, etc.
Location & Logistics
Provide Location Name(s)
Provide the name of where the event or project will take place. If this project is virtual and does not have an address, please mark this as "N/A".
Provide Address
Provide the address of where the event or project will take place.
Additional Locations
If there is more than one location, please provide the list of addresses of the locations (and name if available of locations). Provide if there is parking and where specifically.
Select Where Project Takes Place
Access Requirements
Permits / Approvals
Talent & Interviews
Will people be featured on camera?
If Yes, Please List Names / Titles / Roles
Interview Questions Needed?
If You Have Interview Questions, Please List Them Here:
Media Release Agreements
Branding & Creative Direction
Itineraries/Programs/Script/Talking Points Upload

Please provide any written scripts, talking points, or interview questions if applicable.
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Logos Upload

Please provide any logo graphics of the organization, business, entity, etc that would be needed for branding purposes.
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Brand Guidelines Upload

Please provide any branding guidelines you may have such as a branding book/PDF with Hex Color Codes, Typography Preferences, etc.
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Tone & Style
Visual References Upload

Please provide any upload examples OR share URL links if applicable.
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Post-Production Specifics
Editing Requirements
File Delivery Method
Submission Review & Accuracy Confirmation
Do you authorize Name’s Blue Media to use approved photos, video footage, audio, graphics, or other content produced through this request for marketing, promotional, portfolio, website, social media, and business development purposes?
Please confirm that you have reviewed your request for accuracy and completeness, including grammar, spelling, names, dates, locations, contact information, and all project-specific details. Have you verified that all information submitted is complete and correct?
Select Your Preferred Billing Method
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Media Request Form

Client & Project Identification

Project Scope & Objectives

Service Request Type

Timeline & Scheduling

Location & Logistics

Talent & Interviews

Branding & Creative Direction

Post-Production Specifics

Submission Review & Accuracy Confirmation