FILM SYNCH REQUEST FORM

Email: Alaine.fulton@umusic.com

FROM (insert your contact details):

DATE REQUESTED:

TITLE OF COMPOSITION:

COMPOSER(S):

% PUBLISHER CONTROLS:

NAME OF FILM / PRODUCTION TITLE:-

PROVIDE CONTACT DETAILS OF WHO

WE SHOULD LICENCE THIS USE TO:-

SYNOPSIS OF FILM:-

FILM BUDGET (if any):-

CASTING (if any):-

MUSIC RECORDING YOU WISH TO USE:-

SCENE DESCRIPTION & USE (e.g.

Background):-

APPROX DURATION OF MUSIC USED:-

MEDIA (e.g. TV, Cinema):-

HOW DO YOU WISH TO USE THE

FINISHED FILM:-

TERRITORY REQUIRED (e.g. U.K):

TERM/PERIOD REQUIRED (e.g. 1 year):

FEE:- £TBC(subject to managements approval)

Please note that any fees quoted by

UMPG will be for publishing clearance
only, master rights must be cleared and
quoted separately.