Date
      

       TO:  Lanfranco Music Publishing
                                         
                                                    Attn: Silvia Samalea

     From:
     Organization
       
     Requester's Name
    
     Title
    
      Phone Number      Fax Number        E-mail Address
        
        Notes or Program description
   
   
    We are requesting synchronization License Quote for:
   
    Song Title
   
     Composer
   
     Publishers
   
    Timing
   
    Usage or Purpose
   
    Term
   
    Air Date
   
    Medium
   
    Territory
   
    Total Offer US $
   

   
   Please confirm that the composer/ publisher information listed above is correct.