Espy Music License Request Form

ESPY MUSIC GROUP
BOB A LEW MUSIC
LICENSE REQUEST FORM
PO Box 478
Osprey, FL 34229-0478
Ph: (512) 652-8722

Please use this form to request a mechanical (audio recording), synchronization (film/commercial/television), or print (sheet/folio/reprint) license for a title administered by Espy Music Group.

IF YOU DO NOT HEAR FROM US WITHIN 48 HOURS, PLEASE SUBMIT YOUR INFORMATION VIA FAX OR EMAIL. IT MEANS THE SUBMISSION FAILED.

First Name:*

Last Name:*

Company:*

Address:*

Address 2:

City:*

State:*

Zip Code:*

E-Mail:*

Phone Number:

Use:*

Name of Project (CD, Film, etc.):*

Approximate Date of Release:*

Song(s) to be used:*

Band/Artist Name:* (performing on this release)

Catalog # (if applicable):

# of units to be pressed (if applicable):

Comments:

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