Please fill out all required form fields. The information you provide here will be used by our Licensing Coordinator to draft your representation agreement, so please pay attention to detail.

Important:

All Publishers must have a PRO affiliation and an IPI number
All Writers must have a PRO affiliation and an IPI number
All submitted works must be registered with a PRO and have an ISWC number

Name of Main Contact Person

The person who will be signing the representation agreement on behalf of the band / artist

First Name

Last Name

Main Contact Person's Email Address

Phone

(###)

###

####

Address

When we land a placement for your music, this is the address to which your synch royalty check will be sent

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Artist / Band Name

Album Title

Primary Publisher Name

Primary Publisher PRO Affiliation

Please select Primary Publisher's PRO Affiliation from the pull down. If your PRO is not listed, please select "Other" from the pull-down bar and type your PRO name next to Publisher name, as shown in example above.

Primary Publisher IPI Number

A unique IPI number is assigned to every Writer or Publisher when they register with a Performing Rights Organization

Co-publisher Name

Please complete if any of the works you are submitting are Co-published. Write "none" if all submitted works are published by just 1 publisher

Co-publisher PRO Affiliation

Select Co-publisher's PRO Affiliation from the pull down. If your PRO is not listed, please select "Other" from the pull down bar, and type the name of the PRO next to Co-publisher name above

Co-publisher IPI Number

A unique IPI number is assigned to every Writer or Publisher when they register with a Performing Rights Organization

2nd Co-publisher Name

Write "none" is there is no 2nd Co-publisher

2nd Co-publisher PRO Affiliation

Select 2nd Co-publisher's PRO Affiliation from the pull down. If your PRO is not listed, please select "Other" from the pull down bar, and type the name of the PRO next to Co-publisher name above

2nd Co-publisher IPI Number

if applicable

Writer Name

Writer PRO Affiliation

Select Writer's PRO Affiliation from the pull down. If other, please select "Other" and type PRO next to Writer Name as shown above

Writer IPI Number

A unique IPI number is assigned to every Writer or Publisher when they register with a Performing Rights Organization

2nd Writer Name

if applicable. Write "none" if all songs are written by just 1 writer

2nd Writer PRO Affiliation

Select 2nd Writer's PRO Affiliation from the pull down. If other, please type PRO next to writer name above

2nd Writer IPI Number

If applicable

3rd Writer Name

if applicable. Write "none" if there is no 3rd writer

3rd Writer PRO Affiliation

Select 3rd Writer's PRO Affiliation from the pull down. If other, please select "Other" from the pull down bar and type PRO next to writer name

3rd Writer IPI Number

if applicable

Other Writers + PRO affiliations + IPI Numbers

List any other writers who contribute to this album, including the writers' PRO affiliations + IPI numbers

Song Titles + Writer Splits + ISWC numbers

Enter each song title + writer splits with percentages + ISWC numbers

Music Submission Verification Form

Important: