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 Steve Porter Music Consultant Steve.Porter@boosey.com 0207 054 7249 Vikram Gudi Music Consultant Vikram.Gudi@boosey.com 0207 054 7248

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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