MECHANICAL REQUEST FORM

In order to process the volume of requests we get, priority will be given to those forms that are easily legible and entirely filled in. For more information on licensing, please read the information available on this website. They are very helpful and written to make this process easier for you.

All fields are mandatory except for FAX # if you don't have one and optional additional information.

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Requester Information

Your Name:
Phone #:
Fax #:
Email Address:
Record Label*:
* or your name if no label name

Label Address*
* if you are not using a record label, provide your mailing address.

Address:
City:
State/Providence:	AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDist. of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon
Zip Code:

About Your Record

Name of Artist or Group:
Record Title:
Record Number:
Release Date:
Song Playing Time:
Anticipated Quantity of Units:	Over 5,000 Under 5,000
	Configuration: Quantity: Territory: CD/Tape/Vinyl: US Canada Estimated Download: US TOTAL: Configuration: Territory: CD/Tape/Vinyl US Canada Download US

DOWNLOAD mechanical licenses (i.e. DPD) will only be issued if you have a digital UPC # and an ISRC #.

Digital UPC #:
ISRC #:

Information About The Song You Wish To Use

Title(s):
Writer(s):
Publisher(s):
Additional Information (optional):