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, 2007 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.

SAMARITAN'S PURSE

By:__________________________

Name:_______________________

Title:________________________

Date:________________________

LICENSEE

By:_________________________(troop #)

Name:_______________________

Title:________________________

Date:________________________

 

 

 

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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
 

Name__________________________________________________________________

Address_________________________________________________________________

City____________________________________State_____________Zip_____________

Phone (        )_____________________Referred By:______________________________

Email Address:___________________________________________________

Discover/Mastercard/Visa# _________-________-________- ________

Expiration Date:_______________Have you ordered before?__________________
         
Item #
Description
Quantity
Unit Price
Total Price
OCC-07 Operation Christmas Child $ 1.65 $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
$ $
SUBTOTAL
Regular Shipping & Handling (view chart)
Special Shipping ( next day, priority mail etc)
TOTAL ENCLOSED

You can add other items to this order to save shipping.

PAGE 2 of form

Name of customer ordering______________________________________________