Client Registration

Client Intake Form

Please complete all required fields marked with *. Your information is kept strictly confidential.

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A one-time $100 intake fee is required to complete your registration. You will be directed to a secure payment page after submitting this form.

Personal Information

First Name*

Last Name*

PKA (Professionally Known As)

Label Name (if applicable)

Referred By

Phone Number*

Country Code

Phone Number

Email Address*

Birthdate*

Country*

Street Address*

Apt, Suite, Unit (optional)

City*

State*

ZIP Code*

Role

Select all that apply

PRO Affiliation

Select one

Publishing Information

Don't know your IPI number? Use Songview to look up songwriter, composer, and publisher IPI numbers.

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Author / Composer CAE/IPI Number

Name of Publishing Company

Publisher CAE/IPI Number

Tax & Entity Information

Name on Tax Return*

Social Security Number or EIN*

Identity Verification

This information is required for payment purposes and the prevention of fraud. Please provide a copy of your government-issued photo ID (driver's license, passport, etc.).

Government-Issued Photo ID*

Authorization

I authorize Digital Royalty Distribution LLC to have online account access to my ASCAP, BMI, & SESAC publishing accounts for the following: Live Works Registration, Works Catalog, and Royalty Statements. *

I authorize Digital Royalty Distribution LLC to register song titles, submit claims, disputes, resolve discrepancies, issue licensing agreements, administer the collection & royalty payments on behalf of my publishing designee from all Digital Service Providers (DSP), Performance Rights Organizations (PRO), Mechanical Licensing Collectives (MLC) and all other licensing parties. *

I certify that: The payee's SSN/TIN is correct, the payee is not subject to backup withholding due to failure to report interest and dividend income and the FATCA code entered on this form (if any) indicating that the payee is exempt from FATCA reporting is correct. *

Terms & Conditions

By submitting this form, you agree that Digital Royalty Distribution LLC may act as your authorized representative for all royalty collection, registration, and administration activities described herein. You confirm that all information provided is accurate and complete. You understand that any misrepresentation may result in termination of services. Digital Royalty Distribution LLC reserves the right to modify these terms with reasonable notice. This agreement is governed by the laws of the State of Georgia.

By clicking submit, I agree to the Terms & Conditions above. *

Signature

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Your information is encrypted and kept strictly confidential. A one-time $100 intake fee is required to complete registration.