By submitting information to Pollstar you affirm that if you are providing personal information (e.g. names, e-mail addresses) on behalf of other individuals at your company, you have the consent of those individuals, and you certify that you are complying with any and all applicable privacy and data protection laws in transferring such information to Pollstar. You further acknowledge and agree that Pollstar may use all information provided above in accordance with Pollstar’s privacy policy, which is located at www.pollstar.com/privacypolicy

Distribution Company Update Form

Company Name

Address Line 1:

Address Line 2:

City:

State:

Zipcode:

Country:

Business Phone:

Business Fax:

Company Email Address:

Website:

Staff Roster: Please list each executive staff person including name, direct phone number, title and email address.

Staff (1)

Staff (2)

Staff (3)

Staff (4)

Staff (5)

Staff (6)

Staff (7)

Staff (8)

Staff (9)

Staff (10)

Phone

Title

Email

Labels: Please list each label distributed by your company here. If a label is distributed through another record label, please show the hierarchy involved.

Attach list of distributed labels.

Are you interested in advertising opportunities?

Yes

No

Please send advertising information and rate card to:

Verified By:

Date:

Distribution Company Update Form

List of Forms: