FOOTAGE LICENSING FORM      

Customer Information

Contact Name:
Contact Title:
Company:
Email:
Phone Number:
Fax Number:
Licensee Name
Same as Contact Name/Title
Licensee Address:
Same as Billing Address
Same as Mailing Address
Billing Address
(if different):
Mailing Address
(if different):
Name and Title of Person
authorized to sign license agreement:       
Same as Contact Name/Title



Request Detail

Description/Title Material Requested:
please provide specific names and keywords if possible
Footage Airdate (Approximate)
and Newscast time ie 6pm, 9pm etc.
Proposed Use:
Company Name
(which will run the production):
Territory: Domestic (Specify Country Below)
World Wide (Required for Internet)
Name(s) of Country(ies)
footage to be used in:
Length of License:
Exhibition/Release Date
Media Type (please select all that apply):
DVD
Internet
Film
Theatrical
Standard TV (free TV)
Non-Standard TV (cable, satellite)
Mobile Phone
All Media
Number of runs:
Screener Need By Date:
eg: "1/1/2011", Leave blank if not needed
Master Need By Date:
eg: "1/1/2011", Leave blank if not needed
Master Footage Format:
HD option only for footage back to 2013
For Internet:
Website Address where footage will be viewed
Notes and Comments:
Submit Form To:

   CONTACT      

Address
KGO-TV Video Duplication & Licensing
900 Front Street
San Francisco, CA 94111

Email
KGO-TV.Video@abc.com

Phone
415-954-7005

Fax
415-954-7392
Attn: KGO-TV Video Duplication & Licensing