ÿþ<!DOCTYPE HTML PUBLIC "-//W3C//DTD HTML 4.01 Frameset//EN" "http://www.w3.org/TR/html4/frameset.dtd"> <html> <head> <title>Fair Coverage Request Form</title> <META NAME="description" CONTENT="Fair Coverage Dot Com provides fair and thoughtful studio style script coverage at a reasonable price."> <META NAME="keywords" CONTENT="coverage, analysis, evaluation, script+coverage, script+analysis, script+evaluation, script+feedback, editorial, editorial+consultation, scripts, screenplays, independent, mainstream"> <link rel=stylesheet type="text/css" href="styles/normal.css"> </head> <h2>FAIR COVERAGE DOT COM</h2> <h3>Request Form</h3> <p class="intro">IF A RUSH ORDER, PLEASE INDICATE HERE __.</p> <p class="intro">Name of Client(s):<br> <br> ___________________________________<br> <br> ___________________________________</p> <p class="intro">Mailing Address: ___________________________________</p> <p class="intro">City: ______________________________ State: __________</p> <p class="intro">Zip Code: __________ - _______</p> <p class="intro">Daytime Phone:(_____) _______________<br> <br> Evening Phone:(_____) _______________<br> <br> E-Mail: _______________________@____________________</p> <p class="intro">Title: _____________________________________________</p> <p class="intro">Genre (e.g., drama, comedy, horror/sci-fi): ____________________</p> <p class="intro">A brief description of material:<br> ______________________________________________________________________________________________</p> <p class="intro">Which type of service are you requesting?</p> <p class="intro">Standard Coverage (scripts and manuscripts) __ OR<br> Development Coverage (scripts only) __ OR<br> Editorial Consultation (film & video projects only) __<br> <br> If this is a "Special Offer" (i.e., anything not listed above),<br> please indicate which one in the space below:<br> _________________________________________________________</p> <p class="intro">Length (pages or minutes, as applicable): __________<br> Fee for Service: $__________<br> <br> Paying Electronically via PayPal?<br> Yes __ OR No (payment enclosed) __<br> <br> Has this material been registered with either the Library of Congress/Copyright Office or the Writers Guild of America?<br> Yes __ OR No __</p> <p class="intro">How did you learn about FAIR COVERAGE?</p> <p class="center"> <table border="2"> <tr> <td>Blackflix.com</td> <td>_______________</td> </tr> <tr> <td>IFP</td> <td>_______________</td> </tr> <tr> <td>IMDb.com</td> <td>_______________</td> </tr> <tr> <td>Moviebytes.com</td> <td>_______________</td> </tr> <tr> <td>OBS</td> <td>_______________</td> </tr> <tr> <td>Urban Insider</td> <td>_______________</td> </tr> <tr> <td>Webmovie.com</td> <td>_______________</td> </tr> <tr> <td>Word of mouth</td> <td>_______________</td> </tr> <tr> <td>Search engine (which one)</td> <td>_______________</td> </tr> <tr> <td>Other (please explain)</td> <td>_______________</td> </tr> </table> </p> <p class="intro"> Mail this form along with the Submission Agreement and your Material to the following address:<br> <br> <p class="center">FAIR COVERAGE<br> P.O. Box 2922<br> Culver City, CA 90231-2922</p> <p class="intro">If paying by check or money order, please mail with the above items and make payable to FAIR COVERAGE.<br> </p> <h3>PLEASE NOTE: All items must be received by Fair Coverage (for each submitted script or tape) before the service can begin.</h3> </html>