Boosey and Hawkes - Film, TV & Advertising

	Contact us Ken Krasner Director of Media Licensing ken.krasner@boosey.com (212) 358-5353 Jessica Laun Music Consultant jessica.laun@boosey.com (212) 358-5356 Aaron Brocken Synch Assistant aaron.brocken@boosey.com (212) 358-5354 www.boosey.com/synch Boosey & Hawkes, Inc. 35 East 21st Street 9th Floor New York, NY 10010 FAX: (212) 358-5305

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

Title of Project:*

Nature of Project :*

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

Name of production company or individual licensing the music:*

Name of Musical Work, including movement no., if applicable :*

Name of Composer of Musical Work:*

Master Recording of Musical Work, if known:

Nature of the Usage:*

Duration of Use:*

Duration of license (e.g., life of copyright, 5 years):

Territories License Requested:*

Brief Description of the story of the overall Project and description of the scene(s) containing the Musical Work to be licensed (e.g., action film and work used in car chase scene) and whether there is graphic sex or violence involved): *