Perusal Request Form

Print and complete this form to request one or more perusal scripts from The Play Group Theatre's library of original shows. Send the completed form to The Play Group Theatre, One North Broadway, Suite 111, White Plains, NY 10601 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 _______

CREDIT CARD #____________________________________________ EXP. DATE_________

AUTHORIZED SIGNATURE ________________________________ TITLE _______________