Platinumlooks.com

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Name:

Address:

City/State/Zip/Country:

Phone:

 Email:

Website (if any):

How did you hear about platinumlooks.com?

Band Name (if applicable)

Song Title #1:

Writer(s):

Song Title #2:

Writer(s):

Song Title #3:

Writer(s):

Song Title #4:

Writer(s):

Entrant may submit as many songs as desired.  If you want to submit
more than the four song titles allotted on this form, please Xerox this form or
add the songs on an attached piece of paper and include with your entry. Our service fee is $30.). Click on the Add to cart button for on line payment now.

The categories are as follows:
Hip-Hop/Rap
 

Mail in Payment Method (please Check one):

CashCheckMoney OrderCredit Card
We do not accept international personal checks. You must send a bank check
or international money order in US funds only.

Make your check or money order payable to:
 platinumlooks.com

Total Amount Enclosed or To Be Charged: $30.

Credit Card Information:

Name on card:_____________________________________________________________

Card number:______________________________ Expiration Date _______/________

Address (as it appears on billing statement): ________________________________

I the undersigned, (Print name:)

I authorize the organizers at platinumlooks.com to charge my
credit card for the amount listed above, which covers the entry fee necessary for my
submission into the above mentioned service. I understand that this service fee is
non-refundable, and I have read and understand the Rules And Regulations as posted
on this website.

Signature:

I certify that I am the writer or co-writer of the song(s) and lyrics submitted. I also certify
that I have read, understood and accept the rules and regulations of this web site. If entrant is under 18 years old, the signature of a parent or
guardian is required.

Signature:

Date:

Mail all entries to:
platinumlooks.com 11010 S. Budlong Ave. Los Angeles, CA 90044-1714

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