sony music entertainment change request: address form

SONY MUSIC ENTERTAINMENT
CHANGE REQUEST: ADDRESS FORM
Email: [email protected]
Please complete and return this form by:
* Designates Required Field
Fax:
(201) 777-3047 [Attention: Royalty Helpdesk]
Mail:
Sony Music Entertainment
Attention: Royalty Helpdesk
301 Route 17 North, 11 th Floor
Rutherford, NJ 07070 USA
* Print Name of Sony Music Royalty Payee (Vendor):
* Account Type:
 Artist
 Producer
 Management
 Publisher
 Third Party/Other
* Old Address:
* New Address:
* Email Address:
* Telephone Number:
Royalty Payee (Vendor) Number(s):
Royalty Account (Contract) Number(s):
Please fill in the space below with any additional comments or questions you have for us in this matter.
By signing below, I warrant and represent that: (a) I have full and complete authority to request the change(s) set forth herein to the
account(s) referenced above, and, if the party requesting such change(s) is an entity, I am fully authorized to act and request such
change(s) on behalf of such entity; (b) the implementation of the change(s) requested herein will not violate or infringe upon the rights of
any other party; (c) the information stated herein is truthful and accurate; and (d) I shall indemnify and hold Sony Music Entertainment
harmless against any and all claims and any and all damages, losses or expenses Sony Music Entertainment may incur by reason of
implementation of the change(s) requested herein and/or as a result of the breach of any of the foregoing warranties and
representations.
* SIGN HERE Sony Music Royalty Payee (Vendor):
Notarize
this form
here
* TODAY’S DATE:
* PRINT YOUR NAME HERE:
 Check here to confirm a W-9 Tax Form (U.S. resident) or W-8BEN Tax Form (non U.S. resident) has
been attached to this change request. IF A TAX FORM IS NOT PROVIDED , SONY MUSIC
ENTERTAINMENT MAY BE REQUIRED TO WITHHOLD TAXES FROM YOUR ROYALTY PAYMENT.
Thank you for assisting us in maintaining up to date records regarding your royalty account. Once your form is received by Sony Music, your change request will
be reviewed. We will contact you if additional supporting documentation is required in order to ensure the accuracy and validity of your request. Sony Music
reserves the right to require you to sign and deliver an affidavit affirming the information provided to Sony Music herein.
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