Annual Statement of Account -- Per Program Form

<body bgcolor="#ffffff"> <h2 align=center>ASCAP Annual Statement of Account per Program</h2> <FORM method="POST" action="/cgi-bin/forms/app_confirm.cgi"> <table width=100%> <tr> <td><b>Account Number:</b><br> <input type=text size=20 name=account_number onChange=validate_memb_num(this)> </td> <td> <b>Requested Document Format:</b><br> <select name=doc_format> <option selected>Adobe Portable Document Format (PDF) viewed with plug-in</option> <option>Adobe Portable Document Format (PDF) saved to disk</option> <option>PostScript (PS)</option> </select> </td> </tr> </table> <BR><hr> <table border="0" width=100%> <tr> <th bgcolor="#fff07b">Reporting Period <a href="per_program_help.html#REPORTING" target="help"><img src="info.gif" border=0 vspace=2 align=top></a></th> <td></td> <th colspan=3 bgcolor="#fff07b">Station Covered by This Report: <a href="per_program_help.html#TYPE" target="help"><img src="info.gif" border=0 vspace=2 align=top></a></th> </tr> <tr> <td align="center" rowspan=2>Calendar Year Basis <select name=cal_year> <option selected> </option> <option>1996</option> <option>1997</option> <option>1998</option> <option>1999</option> <option>2000</option> </select> <BR> If less than full year Reporting Period:<br> <input type="text" maxlength=2 size=2 name="start_month"> / <input type="text" maxlength=2 size=2 name="start_day"> / <input type="text" maxlength=2 size=2 name="start_year"> (Month/Day/Year) <br> to <br> <input type="text" maxlength=2 size=2 name="end_month"> / <input type="text" maxlength=2 size=2 name="end_day"> / <input type="text" maxlength=2 size=2 name="end_year"> (Month/Day/Year) </td> <td rowspan=2></td> <td></td> <td valign="top" align="center"> <strong>AM</strong> <input type="radio" name="station_type" value="AM"> </td> <td valign="top" align="center"> <strong>FM</strong> <input type="radio" name="station_type" value="FM"> </td> </tr> <tr> <td valign="top" align=right> Call Letters: <br> Licensee<br> Address </td> <td valign=top colspan=2> <input type="text" size="8" maxlength=4 name="call_letters" onChange=validate_station(this)><br> <input type="text" size="30" name="licensee"><br> <textarea name="address" rows=2 cols="30"></textarea> </td> </tr> </table> <p> <table border=0 width=100%> <tr> <th bgcolor="#fff07b" colspan=2>Other Stations covered by Report <a href="per_program_help.html#OTHER_STATIONS" target="help"><img src="info.gif" border=0 vspace=2 align=top></a></th> </tr> <tr colspan=2> <td align="center" valign="top"> Co-Owned stations<br> (100% simulcast)<BR> <input type="text" size=8 maxlength=4 name="co1a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co1b" onChange=validate_station_type(this)> <input type="text" size=8 maxlength=4 name="co2a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co2b" onChange=validate_station_type(this)><br> <input type="text" size=8 maxlength=4 name="co3a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co3b" onChange=validate_station_type(this)> <input type="text" size=8 maxlength=4 name="co4a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co4b" onChange=validate_station_type(this)><br> <input type="text" size=8 maxlength=4 name="co5a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co5b" onChange=validate_station_type(this)> <input type="text" size=8 maxlength=4 name="co6a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co6b" onChange=validate_station_type(this)><br> <input type="text" size=8 maxlength=4 name="co7a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co7b" onChange=validate_station_type(this)> <input type="text" size=8 maxlength=4 name="co8a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co8b" onChange=validate_station_type(this)><br> <input type="text" size=8 maxlength=4 name="co9a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co9b" onChange=validate_station_type(this)> <input type="text" size=8 maxlength=4 name="co10a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co10b" onChange=validate_station_type(this)><br> </td> <td align="center" valign="top"> Time Broker 100% for: <BR><BR> <input type="text" size=8 maxlength=4 name="co11a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co11b" onChange=validate_station_type(this)> <input type="text" size=8 maxlength=4 name="co12a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co12b" onChange=validate_station_type(this)><br> <input type="text" size=8 maxlength=4 name="co13a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co13b" onChange=validate_station_type(this)> <input type="text" size=8 maxlength=4 name="co14a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co14b" onChange=validate_station_type(this)><br> <input type="text" size=8 maxlength=4 name="co15a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co15b" onChange=validate_station_type(this)> <input type="text" size=8 maxlength=4 name="co16a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co16b" onChange=validate_station_type(this)><br> <input type="text" size=8 maxlength=4 name="co17a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co17b" onChange=validate_station_type(this)> <input type="text" size=8 maxlength=4 name="co18a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co18b" onChange=validate_station_type(this)><br> <input type="text" size=8 maxlength=4 name="co19a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co19b" onChange=validate_station_type(this)> <input type="text" size=8 maxlength=4 name="co20a" onChange=validate_station(this)> -<input type="text" size=3 maxlength=2 name="co20b" onChange=validate_station_type(this)><br> </td> </tr> </table> <p> <table border="0" width=100%> <tr> <th colspan=2 align="center" bgcolor="#fff07b">Fee Computation</th> </tr> <tr> <td><a href="per_program_help.html#GROSS" target="help"><img src="info.gif" border=0 vspace=2 align=top></a> 1. Gross Revenue (excluding non-cash payments in goods and/or services)</td> <td><input type="text" size="20" name="line1" onChange = validate_dollars(this)></td> </tr> <tr> <td><a href="per_program_help.html#LNR" target="help"><img src="info.gif" border=0 vspace=2 align=top></a> 2. Network Revenue for Programs of Licensed Networks</td> <td><input type="text" size="20" name="line2" onChange = validate_dollars(this)></td> </tr> <tr> <td><a href="per_program_help.html#AGENCY_COMMIS" target="help"><img src="info.gif" border=0 vspace=2 align=top></a> 3. Advertising Agency Commissions</td> <td><input type="text" size="20" name="line3" onChange = validate_dollars(this)></td> </tr> <tr> <td><a href="per_program_help.html#POLITICAL" target="help"><img src="info.gif" border=0 vspace=2 align=top></a> 4. Revenue for Political Broadcasts</td> <td><input type="text" size="20" name="line4" onChange = validate_dollars(this)></td> </tr> <tr> <td>5. Less: Agcy. Comm included in Advertising Agency Commissions</td> <td><input type="text" size="20" name="line5" onChange = validate_dollars(this)></td> </tr> <tr> <tr> <td><a href="per_program_help.html#BAD_DEBTS" target="help"><img src="info.gif" border=0 vspace=2 align=top></a> 7. Bad Debts</td> <td><input type="text" size="20" name="line7" onChange = validate_dollars(this)></td> </tr> <tr> <td>8. Less: Bad Debt Recoveries</td> <td><input type="text" size="20" name="line8" onChange = validate_dollars(this)></td> </tr> <tr> <td><a href="per_program_help.html#RATE_CARD" target="help"><img src="info.gif" border=0 vspace=2 align=top></a> 10. Rate Card Discounts</td> <td><input type="text" size="20" name="line10" onChange = validate_dollars(this)></td> </tr> <tr> <td>11. Net Revenue Cleared at the Source</td> <td><input type="text" size="20" name="line11" onChange = validate_dollars(this)></td> </tr> </table> <p> <table width=100%> <tr> <th bgcolor="#fff07b">You may complete the following section to compute your license fee or submit the above information and have ASCAP complete the rest of the form using data submitted in the monthly reports.</th></tr> </table> <p> <center> <input type=submit name=form_action value="Submit form and have ASCAP calulate the license fee"> <p> <input type=reset value="Clear Form"> </center> <p> <hr> <table border="0" width=100%> <tr> <th colspan="8" bgcolor="#fff07b">Enter Weighted Hours of Programs as reported on Monthly Reports <a href="per_program_help.html#WEIGHTED_HOURS" target="help"><img src="info.gif" border=0 vspace=2 align=top></a></th> </tr> <tr> <td>Jan.</td> <td><input type=text size=10 name=hour_jan onChange=validate_dollars(this)></td> <td>Feb.</td> <td><input type=text size=10 name=hour_feb onChange=validate_dollars(this)></td> <td>Mar.</td> <td><input type=text size=10 name=hour_mar onChange=validate_dollars(this)></td> <td>Apr.</td> <td><input type=text size=10 name=hour_apr onChange=validate_dollars(this)></td> </tr> <tr> <td>May</td> <td><input type=text size=10 name=hour_may onChange=validate_dollars(this)></td> <td>Jun.</td> <td><input type=text size=10 name=hour_jun onChange=validate_dollars(this)></td> <td>Jul.</td> <td><input type=text size=10 name=hour_jul onChange=validate_dollars(this)></td> <td>Aug.</td> <td><input type=text size=10 name=hour_aug onChange=validate_dollars(this)></td> </tr> <tr> <td>Sep.</td> <td><input type=text size=10 name=hour_sep onChange=validate_dollars(this)></td> <td>Oct.</td> <td><input type=text size=10 name=hour_oct onChange=validate_dollars(this)></td> <td>Nov.</td> <td><input type=text size=10 name=hour_nov onChange=validate_dollars(this)></td> <td>Dec.</td> <td><input type=text size=10 name=hour_dec onChange=validate_dollars(this)></td> </tr> </table> <p> <table border="0" width=100%> <tr> <th colspan="8" bgcolor="#fff07b">Enter Weighted Hours Subject to Fee as reported on Monthly Reports</td> </tr> <tr> <td>Jan.</td> <td><input type=text size=10 name=fee_jan onChange=validate_dollars(this)></td> <td>Feb.</td> <td><input type=text size=10 name=fee_feb onChange=validate_dollars(this)></td> <td>Mar.</td> <td><input type=text size=10 name=fee_mar onChange=validate_dollars(this)></td> <td>Apr.</td> <td><input type=text size=10 name=fee_apr onChange=validate_dollars(this)></td> </tr> <tr> <td>May</td> <td><input type=text size=10 name=fee_may onChange=validate_dollars(this)></td> <td>Jun.</td> <td><input type=text size=10 name=fee_jun onChange=validate_dollars(this)></td> <td>Jul.</td> <td><input type=text size=10 name=fee_jul onChange=validate_dollars(this)></td> <td>Aug.</td> <td><input type=text size=10 name=fee_aug onChange=validate_dollars(this)></td> </tr> <tr> <td>Sep.</td> <td><input type=text size=10 name=fee_sep onChange=validate_dollars(this)></td> <td>Oct.</td> <td><input type=text size=10 name=fee_oct onChange=validate_dollars(this)></td> <td>Nov.</td> <td><input type=text size=10 name=fee_nov onChange=validate_dollars(this)></td> <td>Dec.</td> <td><input type=text size=10 name=fee_dec onChange=validate_dollars(this)></td> </tr> </table> <p> <table border=0> <tr> <td valign=top> Station was licensed by ASCAP on a per program basis: </td> <td valign=top> <input type=radio name=legacy value=on> on December 31, 1990 <br> <input type=radio name=legacy value=after> after December 31, 1990 </td> </tr> </table> <p> <hr> If the station was licensed on December 31, 1990, fill out the remaining two fields: <BR> <table border=0> <tr> <td>Previous Year's Adjusted Gross Revenue:</td> <td><input type=text size=10 name=old_gross onChange = validate_dollars(this)></td> </tr> <tr> <td>Previous Year's Base Fee:</td> <td><input type=text size=10 name=old_fee onChange 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