700 North Fairfax Street
Suite 601

Alexandria , VA 22314

Phone: (703) 535-8101

FAX: (703) 535-8105
www.aarcroyalties.com

Royalty Distribution Information for
Sound Recording Copyright Owners

The following information is needed to process your royalty payment. Please complete a separate form for each label
or recording company name under which you release product. In the event one record company is collecting the
royalties for more than one label, all such labels may be identified on a single form.

1. Sound Recording Copyright Owner Name:

Label(s):

(if you own more than 10 labels, please attach a printed spreadsheet to this form)

2. Contact Information. Please indicate who we should contact if we need to send you information or ask questions
(this does not include issuing a check -- to indicate a payee, see section 3).

Name:

Company:

Address:

Telephone Number

Fax Number

E-Mail Address:

3. Payment. Tell us to whom you want your royalty payments sent and at what address.

(Please complete this entire section.)

Make the Check Payable to:

Name:

Company:

Address:

Telephone:
Fax:
E-Mail Address:

*We will have to withhold a portion of your royalties and send it to the US Internal Revenue Service if the Copyright Owner does not complete and return to us an AARC-004 form or in the case of a foreign resident, an IRS W-8 Form.

(These forms available in next step.)

3. Record Company Web Graphic Permission (Optional)

I authorize AARC to obtain my record company's logo from our website for display on aarcroyalties.com as a featured AARC member

I DO NOT authorize AARC to obtain my record company's logo from our website for display on aarcroyalties.com as a featured AARC member

FORM COMPLETED BY:

AFFILIATION WITH COPYRIGHT OWNER:

TELEPHONE:   DATE:

SIGNATURE REQUIRED
FORM COMPLETED BY

X ______________________

THIS FORM IS NOT SUBMITTED ELECTRONICALLY, YOU MUST PRINT THIS PAGE PRIOR TO PROCEEDING.