• Name: __________________________________Date:_________________
• Theater Name: (If applicable) ______________________________________
• Address:______________________________________________________
• City: ________________________STATE:__________ZIP:_____________
• _____________________________________________________________
• Country:(If applicable) ____________________________________________
• NAME OF PLAY: ______________________________________________

Burkhart Enterprises is happy to serve you. As you know, the plays offered for sale are protected by copyright laws and are subject to royalty for reading before an audience or production. We assume you intend production. In that case the royalty amount is Thirty Five Dollars ($35.00) and is payable with application. Royalty is for a period of three hundred sixty five (365) days from the date of application and is for unlimited performances during that period. Royalty fee also includes one reproducible script copy and permission is hereby granted for a maximum of twenty (20) copies. . Minor changes to the script are allowable. We thank you.

We agree to the above terms and conditions:

Signed:_____________________________Title________________________

Effective Date:________________

Please copy this form. Make check or money order payable to John Burkhart. Send completed form with payment to address below:

• John Burkhart
• 3409 Neerpark Dr.
• Lincoln, NE 68506
• 1-402-483-1278