Walton Music - License Request Form

	This is a license request form for works published by Walton Music.
FOR REPRINT PERMISSIONS (ONE TIME PHOTOCOPIES) AND REPUBLICATION (SONG BOOKS, HYMNALS, AND OTHER PERMANENT PUBLICATIONS) AND OUT OF PRINT PUBLICATION REQUESTS
Name
Organization
Address
City
State	Zip
Phone no.
Fax no.
E-mail
For photocopy and out or print publication requests:
One time copies
Republication
Out of print publication
Title of Work
Composer
Intended use
Date copies will be used
Qty of copies
For permanent publications (textbooks, hymnals, etc) and out of print publications
Title of your publication
Author/editor
Total no. of copyright works used in your publication
Selling price
Quantity
Territory to be distributed (US/Canada, Worldwide)