New Account Application Form
REQUIRED ACCOUNT INFORMATION
Please provide the following contact information:
Call Letters
Internet Radio ID
Name of Authorized Agent
Address
City
State
Country
Zip/MailCode
Company Listed Telephone Number
Authorized Download Telex ID Number
Fax/2ndPhone
Email
REQUIRED USER INFORMATION
Please provide the following Service-Type information;
Check no more than two (2):
: Radio/TV Broadcaster
: Television Network
: Radio Network
: Video Cable Network
: Audio Cable Network
: Music/Program Director
: Music/Program Syndicator
: Electronic Music Service
: PromoLibrary Broker
: Background Music Provider
: Financial Investor
: Executive Producer
: Record Label
: Record Producer
: Music Publisher
: Music Licenser
: Product Licenser
: Recording Artist
: Song Writer
: Arranger
Copyright © 1990 Bobby Farrell International Network.
International Copyright Secured.
All rights reserved.
Revised: 2005
