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Full Name (Name of writer(s)):
Contact Information (Writer's phone number and other contact information; name/number of agent and/or attorney, if any):
E-mail Address:
Company Name:
Project Name:
Do you have a Contract/Deal Memo (If so, make sure the Guild has it):
Work Done (What were you employed to do OR was it a purchase option? What writing did you do? Television or Theatrical project?):
Delivery Dates/Delivery Information (When did you deliver the literary material and to whom?):
When, if at all, did Company pay? How much? (Date(s) and amount(s) of payment, if any):