Boosey and Hawkes - Film, TV & Advertising - Clearance

	Contact us Natasha Baldwin Head of Consultancy Natasha.Baldwin@boosey.com 020 7054 7245 Jen Moss Music Consultant Jennifer.Moss@boosey.com 0207 054 7247 Lucy Heyman Music Consultant Lucy.Heyman@boosey.com 0207 054 7246 Vikram Gudi Music Consultant Vikram.Gudi@boosey.com 0207 054 7248 You can also check us out on MySpace here

Clearance Request Form

Please fill out this short request form. When you have finished click the submit button. Fields marked with a * are mandatory

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Clearance Details

Specify Medium (Film/TV/Advertising/DVD):*

Film:		Festival:
TV:		Advertising:
Internet:		Video:
DVD:		Radio:
Audio CD:
Other:

Production Title:*

Musical Work:*

Composer:*

First Air/Release Date:

Proposed Period Of Use:*

Total Duration of Use:*

Number of times requested music is repeated throughout the production? :

Territories Licence Requested:*

Specify Media usage for all rights to be licensed :* ?

Titles, Background, Feature:*

Proposed Master Recording (including record label):

(Do you want us to clear or recommend a recording?)

Music Budget:

Synopsis*: ?

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