Mazmania Music Company Form

FORM

Please note that all information is strictly confidential and will never be sold, traded or given away.
Items marked with an asterisk (*) below are essential for us to be able to contact you.
If you prefer to use the e-mail link instead, please don't forget to include these items in your message.

First Name*

Last Name*

Title

Company/Band*

Address

City/Province

State/Province

Zip/Postal Code

Country

Main Phone*

Fax Number

E-mail Address*

Do you have any interest in licensing and/or recording any of the songs on this web site?

Yes (If yes, please select from the lists below. )
No

What is your licensing interest ? (check all that apply)

mechanical
synchronization
performance

How would you like to be contacted about the above mentioned interests?

E-mail
Fax
"Snail" Mail

Would you like to be contacted when changes or additions are made to this site?

Yes
No

If you are any (or all) of the following, please check off all that may apply:

A Recording Artist
Personal Manager
A&R Rep
Attorney who screens material
Agent
A Powerful Leech
Relative or friend of someone famous who could record songs
Complete Nobody
Mom's Favorite Kid
Former Groupie still trying to hang on in the biz
Burned-out "has been" looking for comeback material
Burned-out "never was" looking for big break before pension kicks in

Other (Please describe below, because THIS ONE we've gotta hear)

(To Top Of Page)

Mazmania Music Co., P.O. Box 853 Bayonne, N.J. 07002 (201) 858-0649 (Phone/Fax)
http://www.mazmania.nete-mail: music@mazmania.net

(Disclaimer)

(To get back to Mazmania.com click here)