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Single Use License - Divided We Fall
REQUEST FOR SINGLE USE PUBLIC PERFORMANCE LICENSE - TWELFTH HOUSE FILMS, LLC

The screening host ("Licensee" named in the fourth question on this form) recognizes a contractual agreement for a single use license for the limited, non-broadcast public exhibition of the documentary film entitled Divided We Fall (2017) ("The Film").

The Licensee agrees that he/she shall pay to Twelfth House Films ("Licensor") a licensing fee, agreed upon via email, which shall become due and payable immediately upon receipt of email invoice from Licensor. In consideration of payment of the license fee, the Licensor hereby grants to the Licensee, without warranty, a limited, non-transferable license to screen The Film, subject to the terms and conditions specified herein, as follows:
Email address *
Your answer
Screening date *
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Screening time *
Time
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Licensee - Full name of organization or individual responsible for the license *
Your answer
Your organization type *
If you selected "other" please describe.
Your answer
Key contact person *
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Phone number *
Your answer
Billing name and address *
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Screening venue - full address *
Your answer
Is this event open to the public? *
How many people are you expecting at your event? *
Are you charging admission to this event? *
Does this screening have a corporate sponsor, or are there plans to have a corporate sponsor? *
Full shipping address. This is where we will ship your Blu-ray. *
Your answer
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