Music Box Live Report Usage

Please complete and submit this form prior to synchronization, dubbing or any other proposed usage of any music. After we receive your application, you will receive a license and invoice for the reported usage. If you have any questions, please call the toll free number above. Please use one application per production. Music may not be copied, recorded or otherwise used in any manner or for any purpose, without a written license from MusicBox.
PRODUCTION and ANNUAL BLANKET RATES AVAILABLE - please call 1-866-BOX-0900

PRODUCTION INFO:

Date of Application: Month Day Year

Client:

Producer/Agency:

Production Title:

Production Length: MIN SEC

Production Type: TV Radio Other

Production Air Date: Month Day Year

Term:

Rights:

Commercial ISCI Number:

First 5 words of copy:

My MusicBox Rep is:

LICENSEE (Invoice To):

COMPANY:

ATTENTION:

ADDRESS:

CITY/STATE:

ZIP CODE:

PHONE #:

FAX #:

EMAIL:

PO #

USAGE:

CD#TRACK TITLE# OF USES