Application for a License to Display Trademarks

APPLICANT / LICENSEE INFORMATION

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

LICENSOR INFORMATION

Name: {{licensor_company_name}}

Address: {{licensor_company_address}}

Contact Person: {{licensor_contact_person}}

Phone: {{licensor_phone}}

Email: {{licensor_email}}

APPLICATION DETAILS

Date of Application: {{application_date}}

Desired Start Date of License: {{start_date}}

Desired End Date of License: {{end_date}}

Purpose of Trademark Use: {{purpose_of_use}}

Geographical Territory of Use: {{geographical_territory}}

TRADEMARK(S) SOUGHT TO BE LICENSED

Please list the specific trademarks for which a license is sought, including registration numbers if known:

1. {{trademark_1_name}} (Registration No: {{trademark_1_registration_no}})

2. {{trademark_2_name}} (Registration No: {{trademark_2_registration_no}})

3. {{trademark_3_name}} (Registration No: {{trademark_3_registration_no}})

Additional trademarks may be listed on an attached addendum.

NATURE OF GOODS/SERVICES

Describe the goods or services in connection with which the trademark(s) will be used:

{{goods_services_description}}

MARKETING AND DISTRIBUTION PLAN

Provide a brief outline of the applicant's plan for marketing and distributing the goods/services associated with the trademark(s):

{{marketing_plan}}

DECLARATION

I, the undersigned, hereby declare that the information provided in this application is true and correct to the best of my knowledge and belief. I understand that any false statement made herein may result in the refusal or revocation of the license.

I further agree to abide by all terms and conditions set forth in any licensing agreement granted by the Licensor, and to use the trademark(s) strictly in accordance with applicable intellectual property laws and regulations within the specified geographical territory.

SIGNATURE

___________________________

Name: {{applicant_name}}

Title: {{applicant_title}}

Date: {{signature_date}}