Date

Your Name
Your Organization
Address
City, State  Zip
Phone
Email

Publisher/Copyright Owner
Address
City/State/Zip

Dear Sirs:

I am contacting you to arrange payment of royalties for the musical selections listed below under the compulsory license provision of Section 115 of the 1976 Copyright Act in making and distributing of phonorecords:

CD Title:
Date Recorded:
Tune Title:
Composer:
Publisher:
Length of recording:
Quantity of CD copies:

Please send payment information.

Thanks for your help.

Sincerely,

Your Name