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CLIP & STILL LICENSE REQUEST FORM

HOW CAN WE CONTACT YOU?


Name:
Company

Address

Telephone Number
Email Address

WHAT ARE YOU REQUESTING?

□ Clip □ Still □ Other (describe below)


_______________________________

Requested Title(s)

Description of clip(s) or still image(s)


requested, if known

HOW DO YOU INTEND TO USE THE CLIPS?

Production Title

Description of how requested clips or


images will be used in Production

Term

Territory

Project Deadline

Additional Comments

**Email completed form to clips@lionsgate.com**

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