Music Sample Rights & Clearance Form
Project & Requestor Information
Project Title
Artist
Requestor Name
Requestor Email
Date
Sample Details
Sample Title
Original Artist/Composer
Source (Album/Track/URL)
Sample Duration (seconds)
Used In (Track Name/Section)
Description of Use
Rights & Clearance
Clearance Needed For:
Master Use
Publishing
Other
Copyright Holder(s)
Contacts for Clearance
Clearance Status
Pending
Approved
Denied
Notes