Relaxation, Space Music and Meditation Music by Rising Star

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ULTRA ELECTRONIC ACTIVE

Media Group


Licensing Request Form

Please fill in this form and print. then mail to: Ultra Electronic Active, PO Box 2234 Paradise, CA 95967, USA. Questions? Please contact us!

Personal Data (*= required)

Full Name*:
Company Name:
Job Title / Function:
Phone # and extension: area: phone#: ext.:
Best Time to Contact You:
Your E-Mail Address*:
Your Organisation’s URL:
Address:
City:
State / Province:

Zip / Postal Code:
Country (other than U.S.):

Media elements for which licensing is sought:


•Existing Music media elements from this web-site:

----------> Please select:
















•Custom Created Music or media elements (we also provide graphics design!):



Details about your requests:



Other Media Elements: Digital images, photos, video, graphics, html, other please specify in box above.


Production / Product type for which licensing is sought for:


Please choose your type of production for which you are seeking licensing:

**

Details about your production:



Distribution Range of your Production / Product:

Amount of Copies to be manufactured / distributed:

Countries in which distributed: Worldwide Canada US Mexico Europe South America Middle East India Africa Israel Japan China Taiwan Russia Other

Size of Audience / Viewership / Listenership:


License Types Requested by you (several may apply)


Performance License
New Media License
Synchronization License
Master Recording License
Mechanical License
Videogram License


License Terms sought:


Detail: (especially important when seeking: exclusive or exclusive limited terms)

-> All that are seeking else than “non exclusive” rights:
Production time before publication: (weeks) (mos.) (years)
Length of Terms:



Desired length of terms: (days) (weeks) (mos.) (years)
Product / Production Life: (days) (weeks) (mos.) (years)



Special Requirements / Coments:

Please add any detail not covered above : (e.g. equipment manufacturer seeking licensing for samplers, sound library publishers; or anything you would wish to add)





*Planned budget for all here requested licenses:
(enter 0, if you request licensing terms to be granted free of charge.
- please explain below)

Please enter amount: *


Coments:




Thank you for your time!


You can also print and mail mail to: Ultra Electronic Active, PO Box 2234 Paradise, CA 95967, USA
Contact us for questions!