Copyright Use / License Request Form- DRAFT 0

VIU - SG & Associates POV/PFC - Ehsan Khanaman

Property (Image(s) *

Property Identification: VIU_-02.001 Vision in Unity, Master -2; Sub 001; POV_300.001 Point of View, #001; PFC_305.001 Painting for Charity, #001; Images must be displayed with visible copyright information. Images may be provided with full or incomplete metadata and will be scanned for web presence.

Use Purpose

Advertising
Public Relations
Exhibit
Sales

Multiple uses will be separated for billing purposes.

Duration

S: M: H:D:W:M:Y

Start Date / Time

Date

Time

End Date / Time

Date

Time

Requesting Entity (Licensee)

Campaign Title

The title used for tracking the use and results of this usage.

Distribution Channels *

Social Media
Web Media
Print Media
Product

Define all intended use(s) for this request.

Territories

US Only
Global
Specific Area

Define areas of intended distribution

Product Categories, if applicable

Downloadable Art
Fine Art
Memorabilia
Apparel

Additional information will be required for each request. To establish future royalty payments; Royalty rate; Minimum guarantee payment; advance on signature; Sales Projections: unit sales; average wholesale price; Wholesale sales; Projected Royalty Payment @ %; Minimum Royalty Payment Guarantee. A portion to retire debt; a portion to owner. Information will include expected sale(s) dates;

Licensee Name *

First

Last

Licensee Address

Licensee City, State, Zip

Email *

Phone *

Edification *

Use *

Define the purpose for which this use is requested. Multiple uses will require multiple requests.

Exclusive / Non-Exclusive *

Scheduling of the permission includes protection for each requestor (Licensee) as to target, timeframe and more. If you VIU permissions will be exclusive to other licensees; not to the holder.