Kickin' Country Order Form

This document must be signed by Station Manager or Corporate Officer.


The undersigned Licensee hereby contracts Ghostwriters/Radio Mall ("GRM") to furnish music on CD for radio broadcast only and licenses Materials from GRM for use on radio station named below ("Station").

All Materials supplied by GRM remain the property of GRM.  All rights reserved.  No part of the Materials may be reproduced or duplicated in any form or by any means without the written consent of GRM.  All Materials must be kept in the possession of Licensee at all times.

Licensee shall have the right to use the Materials in accordance with the  terms of this Agreement for a period of forty-nine (49) years from the date hereof.  Materials may be used only on the Station named below.  Use on or by any other station or entity is strictly prohibited.

The undersigned Licensee hereby certifies that Station named below is licensed by the Federal Communications Commission (or equivalent government licensing agency, if foreign licensee) and that said licensee possesses all required performance rights licenses (BMI, ASCAP, SESAC where applicable).  Said licensee agrees to be responsible for the payment of all fees arising from the performance of all Material supplied by GRM. All Material supplied by GRM is copyrighted by various record labels, writers, publishers, and publishing and performance organizations.  Any use by other than said licensee on radio station named below constitutes unauthorized reproduction, prohibited by federal law and subject to prosecution.     


Licensee  (Radio Station call letters)       


Signature of Station Manager or Corporate Officer  


Printed Name and Title  



Please sign and FAX this License And Lease Agreement to 763-522-6256. Or mail it with your check payment to Radio Mall, 2412 Unity Ave N, Minneapolis, MN 55422.  If you have questions, please call us at 800-759-4561 or e-mail us by clicking here!

Use your credit card or send a check or money order for $299 (Shipping is free in U.S. Overseas shipping is $75 for Express Mail) to Radio Mall, 2412 Unity Ave. N., Dept. CTYW, Minneapolis, MN, 55422, USA. MN residents, please add sales tax. All payments must be in U.S. funds. 

For credit card orders, phone 763-522-6256 or 800-759-4561.

Name_________________________________________ Station_____________________________________

Street Address_____________________________________________________________________________

City, State, Zip__________________________________________________Country  ____________________

Phone________________________ FAX________________________ E-Mail__________________________

How you found us __________________________________________________________________________

(verified members only)

____VISA ____ MasterCard ____ American Express ____Discover 


Card#______________________________________ Exp. Date_________Signature____________________________ CCID _____________

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