(Please print, complete and return questionnaire via e-mail, fax or post office mail.)
Information on Company
Name, address and telephone:
Subsidiary or division (if applicable):

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1. Principals or Officers (names and titles):

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• Bank References (name, address and telephone):

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• Trade References (list two names, address and telephone):

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• Present product line including range of retail price points:

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• Annual dollar sales volume:

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• Present sales force (number) and location of showrooms:

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• Location of manufacturing facilities and distribution/shipping points:

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• Current product liability insurance coverage (identity of carrier):

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• Prior licensing experience; current licenses held:

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Proposed Use of Licensed Trademark(s)
11. Specific list of items to be produced including estimated
wholesale and retail price of items:

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Sales and Distribution Information
12. (a) Distribution capability

National/Regional
(b) What type of sales force?

1. In-house
2. Representatives and/or jobbers
3. Total number of sales personnel

(c) Current distribution

	Percent Of	Leading
	Total Sales Volume	Accounts Sold
Department Stores
Specialty Stores
Sporting Good Stores
Mass Merchandisers
Discounters
Catalog Showrooms
Military
Other

• 12.         (a)  Distribution capability

National/Regional
(b) What type of sales force’?

1. In-house
2. Representatives and/or jobbers
3. Total number of sales personnel

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Proposed Methods of Promoting/Distributing Licensed Merchandise

13. Merchandise, marketing, advertising, and promotion plans and concepts for products bearing the licensed trademark(s) should be attached. The submission with the application should be comprehensive in scope and include projections of operations by product categories, the data may be conveyed in outline form.

(a) How will licensed products be introduced and presented to the trade (e.g., types of promotion, advertising, trade shows, etc.):
(b) Proposed channels of distribution to be utilized, (e.g., department stores, specialty stores, mass merchandisers, chain store, wholesalers/jobbers, directmail,catalogshowrooms, military etc.):
(c) Projected annual sales of licensed products for the first three years:

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14. Proposed initial production schedules and quantities:

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15. Individual responsible for negotiating license agreement:
Attach copies of annual reports, product catalogs, ad reprints, or other pertinent information on your company.

Submitted by:

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Title:                                                     Date: