Application form for a film license

In order to work on your request, please provide us with the following information - required boxes are marked with *).

Name and address of the licensee

Company/Name *

Contact person / department *

Street *

Postal / Zip Code *

City *

Country *

Phone

Fax

Email *

Information on the music used

Composer/Arranger *

Work title *

Background music

Duration of the music excerpt used (minutes, seconds) *

The transmission of your inquiry does not inevitably constitute the licensor’s consent to the use of the music required. Our quotation for a synchronization license will be submitted to you as soon as possible.

Anti-spam protection

Please type the name of the composer as it appears in the picture.

I confirm that I am at least 16 years old.

Name and address of the licensee

Information on the music used

Information on the film production