SHOPPING MALL GROUP REPORT FORM - 2007

Licensee:
As of:
SESAC Account Number: - - -
Report Completed by:
E-mail Address:

 

Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:

Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:
Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:

Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:

Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:

Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:

Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT: 		Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:
Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT: 		Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:
Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT: 		Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:
Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT: 		Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:
Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT: 		Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:
Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT: 		Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:
Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT: 		Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:
Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT: 		Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:

Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:

Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:

Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:

Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT:
Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT: 		Premise Name:
Street:
City:    ST:
5 or fewer uses per year?  Yes No
If 5 or Fewer Uses per Year, Dates of Uses:

Gross Square FT: