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Your Full name*
1. Product(s) requested:*
2. Concept:*Give a detailed description of how you plan to use the product.
3. Media:*Describe which media forms are to be used. Eg: Film, television, print, advertising, etc.
4. Length of use:*How long will usage run for?
5. Territory:*Please specify each and every country/territory it will be used/appear/broadcast in.
7. Please note: