SCREENWEST (SW) PROJECT ENQUIRY FORM Date: Project Title: Production Company: Category (e.g. Feature/Doco) & Length: Shooting Format: Est Prod Budget: Est % of budget to be spent in WA: Is there a WA resident Producer attached to this project. If yes please name: SW Fund most likely to apply under: Likely SW investment request: Contact Name 1: Role: Address: Phone Number/s: W: M: W: M: Email: Skype Contact: Contact Name 2: Role: Address: Phone Number/s: Email: Skype Contact: PROJECT STATUS with SCREEN AUSTRALIA Is Screen Australia funding part of the financing plan (please check box) ... If Yes: What date was the preliminary submission made to Screen Australia. Which Screen Australia funding round will this project be considered? Name of Screen Australia Project Manager: Version Dec 2011 2 PROJECT DETAILS State/Country of Residence Name Producers: Executive Producers: Co-Producer/s: Writer/s: Director: Writer/s: Post Production House: Completion Guarantor: Do you have distributor on board? If yes who? ANZ/ROW N/A Line Producer Production Manager: Cinematographer: 1st AD Production Designer: Continuity: Grip: Gaffer: Editor: Sound Designer: Sound Editor/Mixer: Sound Recordist: SHORT SYNOPSIS / LOGLINE (150 words max) (When submitting this form, please include the SCRIPT; TREATMENT or a ONE PAGE SYNOPSIS) LOCATION INFORMATION Have you appointed a Location Manager? If so who? What kind of locations are you seeking? What interests you about shooting in WA? How long do you expect the shoot to be: Total weeks shot in WA: Will you require production office space: Breakdown of locations required: (or attach) EST IMATED SCHEDULE Pre Production: Principal Photography: Post Production: Delivery Date: To To To 3 PROPOSED FINANCE PLAN Finance Source ScreenWest ScreenAustralia Other State Agency Producers Offset ANZ Distribution Sales Agency Confirmed Y/N Amount $AUD % ... ... ... ... ... ... ... ... ... ... PRINCIPAL CAST Actor Confirmed Attached Y/N Character ... ... ... DEVELOPMENT FUNDING Source Stage of Funding Amount $ Please include any additional information that you think may be relevant to this project when returning this form. SCRIPT / TREATMENT / ONE PAGE SYNOPSIS ATTACHED 4 ...