Order Form

Pocket Songs

Secure Order Form

By filling out and submitting the form below you agree to the terms listed on the preceding page.

Please list all the songs you wish to license
10 or more songs @ $110.00 per song
Under 10 songs @ $ 125.00 per song

IMPORTANT
When listing your Song Title selections, each song title MUST BE accompanied by the Album Number.

EXAMPLE: Body and Soul PSCDG 1129

COST INFORMATION

Pricing	Estimate
10 or more songs: number of songs x $110.00 1 to 9 songs: number of songs x $125.00	$0.00

How Will The Tracks Be Used?

Recording for sale

Demo Use

Other

If Other, Please explain:

Your Information:

Name

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Work Phone

Home Phone

FAX

E-mail

Please provide the following payment information:

PAYMENT

Credit Card

Cardholder name

Card number

Expiration/Expiry Date (Month/Year)*:

Return to Pocketsongs.com

IMPORTANT When listing your Song Title selections, each song title MUST BE accompanied by the Album Number.
EXAMPLE: Body and Soul PSCDG 1129

Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail

	PAYMENT
Credit Card
Cardholder name
Card number
Expiration/Expiry Date (Month/Year):*