Name Company Address 1 Address 2 Address 3 City Prov/State Date Rate Code Purchase Order No Production Title Territory Canada Only U.S.A Only CAN & USA Only World (Click here to choose) Type Non-Broadcast/Non-Theatrical Radio-Programme Only Radio Promo Only (station self-promotion) Radio Commercial Only Free-TV Programme Only Pay-TV Programme Only Free-TV and/or Pay-TV Commercial only Free-TV or Pay-TV Promo (self-promotion by stations, pay-TV or cable companies) Teatrical Features and Shorts Only Theatrical Commercial Only Pay-TV and Free-TV Programme Only Theatrical and TV Commercial Only Theatrical and Free-TV Only (excludes Pay-TV) Theatrical and Pay-TV Only (excludes Free-TV) Theatrical, Pay-TV and Free-TV Only Videorecordings Only (videocassettes, videodiscs and all similar media for sale or rent to the general public) Video/Audio Recordings - in addition to any of the categories 01-15 when applied for at the same time (Click here to choose)
2. Information
