Your Contact Information

Artist Name*:

Your Name*:

Address 1*:

Address 2:

City*:

ST/Prov*:

Postal Code*:

Country*:

Telephone*:

Email*: (Use a .edu, .gov, .org, or .mil email address if you have one)

Discount(s) Requested
Choose one and client PR opt-in if desired*:
Educational (10%)Not-For-Profit (10%)First Responder (10%)Active/Retired Military (10%)Opt-In (5%)

Proof of Eligibility
Please submit scanned images of educational, charitable, or first responder membership, student, or employee ID cards. Music instructors may submit available documentation or give details below.

Attach scanned image documents here in bmp/gif/jpg/jpeg/pdf/png/tiff/zip formats only. Please zip/compress first if submitting multiple files:

Please add any additional eligibility information, such as non-profit EINs, organization information, etc.:

Attestation and Acknowledgement
I attest that the information I am submitting is truthful, has not been fabricated to mislead, and that I am eligible for the Electric Owl Works discount(s) I am claiming. I acknowledge that my submission will be evaluated for eligibility by Electric Owl Works, who will notify me via email of their determination.

*I also understand that if I choose to opt-in, Electric Owl Works may use my/our artist name, likeness, audio samples, and Internet URLs for promotional purposes.

I Agree