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Limited,
Nonexclusive Service Mark License
APPROVAL FORM
1. The Licensor, Samaritan's Purse, a charitable
organization located in Boone, North Carolina (hereinafter
"SP"), and the Licensee (hereinafter "Licensee")_______________________________(your
name or troop number) understand and agree that the
words "Operation Christmas Child" and "Samaritan's Purse"
are Service Marks federally registered and protected by SP.
Licensee also understands and agrees that the Operation Christmas
Child mark design and logo are owned and registered by SP.
2. Licensee agrees not to use any Service
Mark mentioned or described in Section 1 without the written
permission of SP.
3. SP hereby grants a limited, nonexclusive
license to _________________________ (your name) of TROOP
NUMBER_________________to use for the limited purpose(s) and
for the term set forth below.
4. Pursuant to this License, Licensee is
permitted to use the Operation Christmas Child Service Marks
for the purpose(s) of :
A PARTICIPATION PATCH
5. This Limited, Nonexclusive License shall
expire December 31, 2008 and any future use or different use
of the Service Marks described herein are not permitted without
the written permission of SP.
6. This License may be terminated by either
party with seven (7) days written notice.
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SAMARITAN'S PURSE
By:__________________________
Name:_______________________
Title:________________________
Date:________________________
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LICENSEE
By:_________________________(troop #)
Name:_______________________
Title:________________________
Date:________________________
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You
can print this form !!!
Please
complete this form and mail it or fax it to:
Patchwork Designs, Inc.
8421 Churchside Drive
Gainesville, VA 20155
( 703)743-9948 PHONE
( 703)703-743-9942 FAX
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Name__________________________________________________________________
Address_________________________________________________________________
City____________________________________State_____________Zip_____________
Phone ( )_____________________Referred
By:______________________________
Email Address:___________________________________________________
Discover/Mastercard/Visa# _________-________-________-
________
Expiration Date:_______________Have you ordered before?__________________
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Item #
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Description
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Quantity
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Unit Price
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Total Price
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| OCC-07 |
Operation Christmas Child |
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$ 1.65 |
$ |
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SUBTOTAL
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Regular Shipping & Handling (view
chart)
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Special Shipping ( next day, priority
mail etc)
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TOTAL ENCLOSED
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You can add other items to this order to save
shipping.
PAGE 2 of form
Name of customer ordering______________________________________________
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