Corey Wright Music Distribution Services

945 43^rd Street, #102, Sacramento, California 95831

Contact Information Form

First Name: ___________________ Last Name: ____________________ M ______

Address: ____________________________________________________________

City: _______________________ Country: ______________________ State: _____

Postal Code: ______________ Phone Number:_______________________________

Fax Number: _______________ Company Name: _____________________________

Tax I.D. #: ______________________    Email: ______________________________

PayPal Account :________________________________________________________

What is your music genre?________________________________________________

Does your work include explicit lyrics?_______________

What is your web address?_________________________________________________

What is your referral Code? ________________

Are you a recording company or an independent artist?___________________________