Musiodata provides musicology services for attorneys, advertisers, music companies, film companies and other entertainment professionals.

Music Clearance Request Form

Please fill out the form here and someone from our office will contact you shortly. Note: All information is kept confidential. Please read Terms & Conditions.

Where to Upload Music Files

After filling out the form below, please upload music files for review to: https://www.dropbox.com/request/r90LuYoz4j4imljU6k2z
You can also download this form as a Word document.

Name

First Name

Last Name

Title

Company

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number

(###)

###

####

Fax

(###)

###

####

Email Address

Preferred Contact

Rush Priority

I certify that if this work is reminiscent of any other known piece, group or singer, or if I have been asked to create music similar to something else, I will indicate those titles or artists below:

Check here if a reference track or tracks were used

Check here if another party was approached for a quote or for licensing.

Check here if no samples were used.

Otherwise, please list samples and sources

Music to be cleared (List title(s), time (TV/R) Or other identifiers:

Client

Product

Send Bill To

Agency

Music Company

Phone

(###)

###

####

Business Affairs Person if PO Required

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Other Comments

By checking this box, I certify that the above information is true and correct to the best of my knowledge and I have read and agreed to the Musiodata Terms and Conditions.

By checking this box, I agree to pay for services rendered. If another party is responsible for payment, I have received approval from that party and they are listed above.

ALL APPLICABLE FIELDS MUST BE FILLED OUT BEFORE WORK IS DONE