R E Q U E S T   A   Q U O T E 


Please complete this form with all relevant information.

Invoice To:
License To:
Date
Date
Attention
Attention
Phone Number
Phone Number

Best Time To Be Reached

Best Time To Be Reached

Fax
Fax
E-mail
E-mail
P.O.#
 

Clearance License Categories  (Check all that apply:)

Broadcast Production 

Local  (US & Canada only) 

TV Radio

Regional  (US & Canada only) 

TV Radio

Network  (US & Canada only) 

TV Radio

Network  (Worldwide) 

TV Radio
Program

Local

TV Radio

Syndicated or Network

TV Radio

Infomercial

TV Radio

Internet (On-line Productions)

TV Radio
Common Carrier (planes, etc.)

All Broadcast Rights

(TV & Basic Cable, Satellite, Premium Cable & Production for Sale to the General Public up to 10,000 copies.)

All Non-Theatrical Rights

(Non-broadcast, Educational, Government, Corporate non-broadcast)

Premium Cable Production (HBO, Disney Channel, Showtime, etc.)
Cable Network Origination

Promotional Spot (includes PSA's)

Promo Spot (US & Canada Only)

Promo Spot (Worldwide)

Pay-Per View

Program

Cable Film

 
Production for Sale in Limited Market
(Corporate, Industrial, Sales, etc.)

Audio Cassette or CD

Video Cassette or DVD

Multimedia Hard Disc (non-interactive)

Distribution over 10,000 copies

Retail Sales (General Public)

Audio Cassette or CD

Video Cassette or DVD

Multimedia Hard Disc (non-interactive)

Distribution over 10,000 copies

Audio Visual Production
Non- Broadcast (Audio or Video Cassette/Disc, Slides Film or Multimedia Hard Disc. Non-Interactive Production)

Up to 500 copies of production

Up to 10,000 copies of production

Multimedia Production
Interactive (Non-Linear) Production - (CD-ROM or Hard Disc)

Production NOT for Sale

Production for Sale (Limited Market)

Production for Sale (Retail)
Total # minutes in source file

Theatrical Production

Trailer or Commercial

Trailer or Commercial (All Rights)

Film  (Theater Release Only)

Film  (All Rights)

Festival/Theme Park Rights

Distribution > 10,000 copies

Production Info. Territory
Product
Production Title/URL
Air Date(s)
Length
Min. Sec.
Ad Agency
ISCI#
Station(s)
1st Line of Copy
Misc./Comments
City, State

Regional

National (US/Canada)
Worldwide
Cue Sheet Codes (use below if applicable)
       BI: Background Instrumental VI: Visual Instrumental EE: Logo
BV: Background Vocal VV: Visual Vocal
TO: Theme Open TC: Theme Close


Tracks 

  Song Title CD-Track# BMI # # 0f Uses Cue Sheet Codes
(see above definitions)
1
2
3
4
5

If you have questions or comments, please contact us.

 Copyright 2015,  James E. Tessier   (623)298-5034,  All Rights Reserved
license@surfviewpublishing.com