General Information:

Agency Name:

Client:

Product:

Commercial ID Number:

Commercial Title:

Client PO Number:

Client Job Number:

Estimate Number:

Theatrical/Industrial Exhibition Start Date:     End Date:

Up to 30 Consecutive Days Use Only 
(100% of applicable Session Fee)

 

Additional use Beyond the Original 30 Consecutive Days

(60% Additional of Applicable Session Fee)

More Than 30 Days Use
(160% of Applicable Session Fee)

 

Note: Theatrical/Industrial exhibition of a broadcast commercial may not be used beyond the maximum period of use without additional payment.

 

Notes:

Submitted and Authorized by: