Client Intake Form

1
What type of services are you looking for?* This field is required.
Please Select
Please Select
Collections Deal
Co-Publishing Deal
Admin Deal
Don't Know
2
Are you a(n) Artist or and a Authorized Label Representative?* This field is required.
Please Select
Please Select
Artist
Authorized Label Rep.
Both
3
Legal Name* This field is required.(We are only collecting this information due to registration purposes via signed in contract to act as administrator on the behalf of songwriter)
First Name
Last Name
4
Date of Birth* This field is required.(We are only collecting this information due to registration purposes via signed in contract to act as administrator on the behalf of songwriter)
Date
Month
Day
Year
5
SSN* This field is required.(We are only collecting this information due to registration purposes via signed in contract to act as administrator on the behalf of songwriter)
6
Picture of Legal/Active Photo Identification (Front side only)* This field is required.(We are only collecting this information due to registration purposes via signed in contract to act as administrator on the behalf of songwriter)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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7
Address* This field is required.For purpose of having to mail security sensitive material and or documents
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
8
Phone Number* This field is required.(We are only collecting this information due to registration purposes via signed in contract to act as administrator on the behalf of songwriter)
Please enter a valid phone number.
9
What is the most convenient time to call?* This field is required.
Please Select
Please Select
AM
Afternoon
PM
10
Email* This field is required.(Due to having sensitive information on this form we ask as a security measure to verify your email)
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code?or
Receiving the email may take a few minutes, thank you for your patience!
11
Artist Name* This field is required.
First Name
Last Name
12
Are you currently signed to a publishing company?* This field is required.
YESNO
13
If yes, whom?* This field is required.(if no, fill N/A)
14
Are you currently signed to a record label?* This field is required.
YESNO
15
If yes, whom?* This field is required.(if no, fill with N/A)
16
Are you currently being represented by management?* This field is required.
YESNO
17
If yes, whom?* This field is required.(if no, fill N/A)
18
Are you currently registered with a PRO?* This field is required.
Please Select
Please Select
I don't know
No
ASCAP
BMI
Other
(Performance Rights Organization: ASCAP, BMI, Other)
19
If other; whom?* This field is required.(if no or I don't know, fill N/A)
20
If registered, what is your (IPI#)?* This field is required.(if no or I don't know, fill N/A)
Interested Party Information (IPI#)
21
Are you currently registered with sound exchange?* This field is required.
YESNO
22
If registered, what is your (SXID#)?* This field is required.(if no, fill N/A)
Sound Exchange Identification (SXID)
23
Are you currently registered with a distribution platform?* This field is required.
YESNO
24
If yes; which distribution platform?* This field is required.(If; no or I don't know fill N/A)
25
Are you currently registered with Soundcloud?* This field is required.
YESNO
26
If yes; what is your Soundcloud?* This field is required.(If no, fill N/A)
(Place link here)
27
Do you currently have a EPK?* This field is required.Electronic Press Kit (EPK)
YESNO
28
If yes; add link* This field is required.(If no, fill N/A)
(Place link here)
29
Do you have a official website?* This field is required.
YESNO
30
If yes; add link.* This field is required.(if no, fill N/A)
31
Do you own any social media platforms?* This field is required.(Facebook, Instagram, X (formerly twitter), ect.)
YESNO
32
If yes; select which ones are currently active.* This field is required.
Facebook
Instagram
X (formerly Twitter)
TikTok
Pinterest
Tumblr
LinkedIn
YouTube
Other
33
Add all social media platform link(s) that you own.* This field is required.
34
Are you a Previous Client?* This field is required.
Please Select
Please Select
I don't know
Yes
No
35
If yes; what is your (GSPC#?)* This field is required.(if no, fill with N/A)
36
Additional information you want us to know:
37
30 Min Meeting
38
Please verify that you are human* This field is required.
Should be Empty: