Request Permission For Special Use Of Our Music

Fields in red with a * are required.

*Your name:

*Your e-mail:

*Would you like a copy of this request sent to the above e-mail address?

Yes No

*Your organization's name:

*Your organization's street address:

*Your organization's city:

*Your organization's state/province:

*Your organization's Zip:

Date of performance or event (if applicable):

*Select the category that best fits the type of request you are making:

If applicable, estimate the number of CDs/DVDs/videos to be made:

If applicable, price to be asked per CD/DVD/video:

*Briefly describe exactly what you are asking permission to do:

*Include the exact title of any Plank Road Publishing song you wish to use:

Please contact the publisher and not the distributor for permissions. We can only grant permission on Plank Road Publishing products.

*Indicate if the project is nonprofit or for profit:

Non-profit, i.e., a fund-raiser for your organization, OR Profit, i.e., a CD or other media which will be sold to the general public

Project is non-profit

Project is for profit

*Please indicate where the proceeds will go:

Organization's music program

Organization

Charity: Specify:

Self

Other: Specify:

None (check this if no profits are involved)

Permission Request Form