Permission Request Form

Use this form to 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


Charity: Specify:


Other: Specify:

None (check this if no profits are involved)


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