Date:____________________________________


SONG TITLE: ________________________________________________________


ARTIST TO RECORD: _________________________________________________


LABEL: _______________________________________ (Major? Indy? Self-Promo?)


ALBUM TITLE: ________________________________________________________


TYPE OF ALBUM: ______________________________ (Single Artist? Compilation?)


USAGE: __________________________ (Sample? Parody? Standard Recording?)


FORMAT(S): _________________________ (CD? Digital Download? AudioStream?)


LENGTH OF TRACK: ______________________ (Minutes / Seconds)


TERRITORY: ______________________ (Worldwide? US Only?)


RELEASE DATE: ______________________ (Month, Day, Year)


UNITS PRODUCED: ______________________


METHOD OF SALE: ______________________ (Retail? Online? Self-distribution?)


WHOLESALE PRICE: ______________________


RETAIL PRICE: ______________________


ROYALTY RATE: ______________________ (Rate you're requesting? Full stat?)


PURPOSE: __________________________ (For sale? Premium? Promo only?)


LICENSEE: _________________________________________________________


(Name, Company) ____________________________________________________


__________________________________________________________________


(Address) __________________________________________________________


__________________________________________________________________


(Phone) ___________________________


(Fax) _____________________________


(E-mail) ___________________________


Options requested: _____________________________________________________


____________________________________________________________________

Exclusivity? YES ____ NO ____


Parody lyrics? YES ____ NO ____



If yes, please attach new lyrics to your request if currently available.



Production/Music budget: _________________________


Comments:


________________________________________________________________________


________________________________________________________________________


________________________________________________________________________


________________________________________________________________________


________________________________________________________________________


 

Thank you for our interest in this FLMG Song.
Please complete this form and fax it, along with any additional elements
(i.e. film synopsis, parody lyrics)
to the following number:

FLMG  FAX:
(925)  472-0417

We will be in touch with you.