Perusal Payments

You may print this form to make payment for perusal rights to The Play Group Theatre. Send the completed form to The Play Group Theatre, 25 Stratford Avenue, White Plains, NY 10605 or for more immediate service FAX to 914-946-1336.

Your completion and submission of this form does not create a licensing agreement nor authorize your use of the requested performance material. You must make application for performance rights for any use of the material whether in part or in whole.

This payment does not permit you to make multiple copies of the script. One perusal script is purchased per perusal script payment.

SCHOOL / ORGANIZATION NAME ______________________________________________________
SHIPPING ADDRESS ________________________________________________________________
CITY _____________________________________ STATE _______________ ZIP ____________
PHONE (________)__________________________ FAX (________)_________________________
YOUR NAME _______________________________________________________________________
EMAIL _______________________________________________________________________
ORG. WEBSITE/URL_____________________________________________________________

PLAY TITLE ________________________________________________________________________
NUMBER OF PERUSAL COPIES ______

ADDL PERUSAL TITLE __________________________________________________________________
NUMBER OF PERUSAL COPIES ______

[ ] ONLINE PERUSAL ($6 each) or [ ] MAILED PERUSAL ($10 each - includes regular shipping)

NUMBER OF PERUSALS ______ x COST EACH _______ = TOTAL PAYMENT ___________

Call 914-946-4433 for more information about use of this copyright material or e-mail the Publications Manager with any questions.