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License Request Form – Mary Grigolia

License Request Form

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