License Request Form – Mary Grigolia

Please click the link below to pay for the appropriate license via PayPal, then fill out the form to submit your information.

Title of song to license*
Check appropriate*
- License to copy, one-time ($25)
- License to copy, perpetual ($50)
- License to perform ($50 or $1 per copy or per person in your choir)
Contact Name*
FirstLast
Prospective Licensee*
Nature and size of Prospective Licensee (e.g., 30 member choir, 400 members congregation, school)*
How and when will the song be used? *
Prospective Licensee address*
Street AddressAddress Line 2CityState / Province / RegionZIP / Postal CodeCountry
Prospective Licensee phone*
Prospective Licensee email*
Prospective Licensee website