Phifer Media Management, LLC
Submission form
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Upon our request of a completed script, please print and fill out the submission form listed below. The form can be mailed to our attention.

2420 Hunter Ave Ste 20A
Bronx NY 10475
Tel: (646) 306-7298
Dear Phifer Media Management: 
1. I, ____________________, am submitting to you
herewith the following material 
(hearinafter referred to as 'said material'): TITLE: ___________________
FORM OF MATERIAL (e.g. screenplay, treatment, novel, play, movie, etc.): 
                                    REGISTRATION NO. (If any):_______________ 
COPYRIGHT REGISTRATION (If any):_______________
                                    I request that you read and evaluate said material
                                    a view to decide whether you will undertake to represent it. If you subsequently decide to represent me as a manager, we will
                                    enter into a written management agreement. 
                                    I represent and warrant that I am sole owner and author of said material, that I 
   have the exclusive right and authority to submit and/or convey the same to you
upon the terms and conditions stated herein. I agree to indemnify you and your
employees from any and all claims, losses or liabilities (including reasonable attorney's fees) that may be asserted against you or any of your employees or
incurred by
                                    you or your employees at any time in connection with said material, or any use thereof, in connection with any breach or alleged
                                    breach of the foregoing representations and warranties. 
4. I agree that any part of said material which does not in itself constitute protectable literary property may be
                                    used by you or any of your employees without any liability to me, and that nothing in this agreement nor the fact of my submission
                                    of said material to you shall be deemed to place you in any different position than any member of the public with respect
                                    to such material. 
5. I understand that you
                                    receive numerous unsolicited submissions and that you have access to and/or may create or have created literary material,
                                    formats, stories and the like, and that many such submissions received by you are similar or identical in theme, idea, plot,
                                    or other respect to those developed by you or your employees or otherwise available to you. I agree that I will not be entitled
                                    to any compensation 
because of the use by you of any such similar or identical material.
6. I understand that you have adopted the policy, with respect to the unsolicited 
   submission of material, of refusing to accept, consider of evaluate unsolicited
material unless the person submitting such material has signed an agreement in
                                    a form substantially the same as this agreement. I specifically acknowledge that you would refuse to accept, consider, or
                                    otherwise evaluate my material in the absence of my acceptance of each and all of the provisions hereof. I shall retain all
                                    rights to submit this or similar material to persons other than you. I understand that no confidential relationship is established
                                    by my submitting said material to you hereunder or by reason of agreement between us. 
7. You agree that if you use any legally protectable portion of said material, provided
it has not been obtained by you from, or independently created by, another source,
you will pay me an amount which is comparable to the compensation normally paid by you for
                                    similar material or an amount equal to the fair market value therof, as of the date of this agreement, whichever is greater.
8. In the event of any dispute concerning
                                    alleged use of said material (e.g. whether 
you have used legally protectable portions thereof), or any other dispute arising
out of or in connection with said material or with reference to this agreement, its validity,
                                    construction, performance, nonperformance, operation, breach, continuance or termination such dispute shall be submitted to
                                    arbitration. Each party hereby waives any and all rights and benefits which he or it might otherwise have or be entitled 
to under the laws of New York to litigate any such dispute in court, it being the
intention of the parties to arbitrate,
                                    to the provisions hereof, all such disputes. The arbitration shall be conducted in the County of New York,
                                    State and except as herein expressly provided otherwise, the arbitration shall be a person experienced and knowledgeable in
                                    the entertainment industry. The arbitrators' decision shall be controlled by the terms of this agreement, and I agree that
                                    the amount of any award shall be in the amount which is comparable to the compensation normally paid by you for similar material
or an amount equal to the fair market value thereof as of the date of this agreement,
                                    whichever is greater. 
9. I have retained at
                                    least one copy of said material, and I hereby release to you of 
and from any and all liability for loss or damage to, the copies of said
material submitted to you hereunder.
10. I
                                    enter this agreement with the express understanding that you agree to read 
and evaluate said material in express reliance upon this agreement and my
covenants, representations, and warranties contained herein, and that in the
absence of such an agreement, you would not read or evaluate said material.
11. Except as otherwise provided in this agreement, I hereby release you from any 
and all claims, demands, losses, liabilities, of every kind whatsoever (including
reasonable attorneys' fees)that may arise in relation to the said material or by
reason of any claim now or hereafter made by me that you have used or
appropriated the said material except for fraud or willful injury on your part.
12. I hereby state that I have read and understood this agreement and 
that no oral representation of any kind have been made to me, and that this
agreement states our entire understanding with reference to the subject matter
13. If more than one party signs this
                                    agreement as submitter, than reference to "I" 
and "me" throughout this agreement shall apply to each such party, jointly and
severally, and each agrees to be liable, jointly and severally, for all obligations 
under this Agreement.
14. This agreement shall
                                    be governed by laws of the State of New York
applicable to agreements executed and to be fully performed therein.
signature                                 signature

_________________________ _________________________
print name                              print name

                                                                        Phifer Media Management, LLC