License Request Form

License Request Form

Please fill out all required fields and upload your proof of concept.
Licensee & Contact Info
Company/Licensee Name
Company/Licensee Address

Street Address

Street Address Line 2
CityStateZip CodeCountry
Company/Licensee Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Company/Licensee Email
example@example.com
Contact Name

First NameLast Name
Contact Phone Number (If different than above)
Please enter a valid phone number.Format: (000) 000-0000.
Contact Email (If different than above)
example@example.com
Billing Contact Information (if different than above)
Project Info
Project/Production Title
Release Date

MonthDayYear
Date
Project/Production Synopsis
Current Project/Production Status
Currency
Project/Production Type

Other
Total Production Budget
Budget Range Allocated for Licensing
Territory of Exhibition
Project/Production Deadlines Relevant to License Request
Rights Requested
Media Rights Requested

Other
Expected Distribution Platforms
Term (duration of license)
Option(s)
Any in or out of context promotional/advertising use?
If yes, describe promotional/advertising use in detail
Asset Details
Assets Requested for Licensing (be as specific as possible)
Duration of Each Requested Asset(s) & Number of Use(s)
Description of Each Use
Timecodes (if applicable)
Proof of Concept Upload (pitch deck, script pages, rough cuts, project or company website/socials, promotional images, etc.)

Cancelof
Should be Empty: