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Your details:
Your Name:
Company name:
ABN:
Email:
Address:
Phone number:
Usage details:
Title of production:
Client name: (i.e. Nokia)
Production/ Product description: (i.e. Lumia 215 Mobile)
Are you producing multiple videos / edits / variations? If so, please give details
Production / Commercial Duration: (mm:ss)
Key number(s):
Track title and Composer name:
If you have used other tracks, please list track title(s) / composer(s):
Additional Comments:
RADIO BROADCAST DETAILS (IF APPLICABLE):
Will this be broadcast on radio? - If no, move onto the next section.
YES
NO
Will this be broadcast on Australian radio?
YES
NO
If yes, please specify national or specific states and territories:
If yes, please also specify the campaign duration on Australian radio:
Will this be broadcast on radio in other countries?
YES
NO
If yes, please specify countries and broadcast details: (channels/networks)
If yes, please also specify the campaign duration:
If broadcast on New Zealand radio, list Auckland, Wellington, Christchurch or national:
TELEVISION BROADCAST DETAILS (IF APPLICABLE):
Will this be broadcast on television? - If no, move onto the next section.
YES
NO
Will this be broadcast on Australian television?
YES
NO
If yes, please specify national or specific states and territories:
If yes, please also specify the campaign duration on Australian television:
Will this be broadcast on television in other countries?
YES
NO
If yes, please specify countries and broadcast details: (channels/networks)
If yes, please also specify the campaign duration:
If broadcast on New Zealand television, list Auckland, Wellington, Christchurch or national:
OTHER USAGES / COMMENTS / DETAILS
Please outline any other usages including details of any TV, film or documentary productions:
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