Request For Approval to Use Lana's The Little House Brand Features

Print this form, provide the required information on separate sheets, and fax your request to the Permissions Agent at 815-846-8509:

1.      Exact name and title of organization and/or person requesting permission (prospective "licensee" of Lana's The Little House property), and contact information (e-mail, phone, fax, mailing address).

2.      Attach layout/sample of visual that features any Lana's The Little House trademarks, logos, service marks, trade dress, slogans, screen shots, copyrighted designs, copyrighted photographs or other brand features (collectively "Brand Features"). Please note that any material which features any trademarks, logos or copyrighted material (including banners and buttons) from any third party may require that third party's and/or others' specific and additional permission. Lana's The Little House makes no representation or warranty as to your proposed use of any such material.

3.      Specific description of materials in which Lana's The Little House trademarks and/or copyrighted materials will appear. Please include:

A.     Type of work (book, video, etc.) and Title

B.     Name all contributing authors and editors of the work

C.    Description of content of work (be as specific and thorough as possible)

D.    Distribution plans for materials (what territory, how many copies, how long will copies be offered for distribution, what are requested channels of distribution).

4.      Any other questions concerning your request.
 

I acknowledge that I have reviewed the Copyright Policy guidelines for use of Lana's The Little House Brand Features, and that I and my organization will agree to those Guidelines, and any additional terms set forth within Lana's The Little House Approval Notification and/or License, which terms will collectively govern any use of Lana's The Little House Brand Features in relation to this Request.
 

Signed:

____________________________________________

 

Name:  

_______________________________________

Title:  

_______________________________________

Organization:  

_______________________________________

Date:  

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