Content Information Form

Required for All Sources

Incomplete Information May Result in Delaying Your Order

Selection Title:

 

Selection #:

 

Company Name:

 

Your Name:

 

Phone (Fax/Pager Not Acceptable):

 

Ordered for (customer's name)*:

 

*If you are a broker, you are required to disclose the name of your end-customer (for informational use only).

Documentation of permission from the copyright owner to reproduce this title must be attached to this form.

 

ORDER INFORMATION

Distribution

Media

 

Internal - Within Organization

 

CD

 

External - Retail

 

DVD

 

External - Freely Distributed

 

 

 

ROM

Content

Indicate Included Software Products

Distribution Rights

 

Game

 

 

 

Owned

 

Licensed**

 

Application

 

 

 

Owned

 

Licensed**

 

Database

 

 

 

Owned

 

Licensed**

 

Operating System

attach additional pages as needed

**supporting documentation Required

 

Multimedia

 

 

Software Compilation

Any contents compressed or encrypted?

 

Yes

 

No

 

Shareware/Freeware

If yes, specify instructions for decompressing and/or decrypting:

 

MP3**

 

 

Enhanced CD**

** Also Complete Audio Section

 

AUDIO

Content

Track #/Title/Artist/Time

Distribution Rights

 

Spoken Word

1

 

 

 

Owned

 

Licensed**

 

Broadcast Program

2

 

 

 

Owned

 

Licensed**

 

Karaoke/CD+G

3

 

 

 

Owned

 

Licensed**

 

Soundtrack

4

 

 

 

Owned

 

Licensed**

 

Live Performance

5

 

 

 

Owned

 

Licensed**

 

Single Artist/Band

6

 

 

 

Owned

 

Licensed**

 

Compilation

7

 

 

 

Owned

 

Licensed**

 

Music Style

8

 

 

 

Owned

 

Licensed**

 

9

 

 

 

Owned

 

Licensed**

10

 

 

 

Owned

 

Licensed**

attach additional pages as needed

**supporting documentation Required

 

VIDEO

Content

 

Distribution Rights

 

Broadcast Program

 

Promotional

 

 

Owned

 

Licensed**

 

Music Video

 

Documentary

 

 

 

 

 

 

Karaoke

 

Other

 

 

 

 

 

 

Countries of Distribution:

 

 

 

I affirm that all information provided herein is true and that all disc contents are properly licensed for replication under the terms of the original rights holder(s).  Proof of such licensing and/or trademark authorization is attached.  I agree to abide by High Speed Video’s Terms and Conditions and the Anti-Piracy Compliance Program guidelines of the International Recording Media Association. High Speed Video will maintain one source copy for at least one year, will incorporate a source code in all glass masters, and reserves the right to refuse the processing of any order not complying with the Anti-Piracy Compliance Program guidelines.

Signed:

 

Date

 

Print Name:

 

Title: