Woodsy Owl Licensing Program Licensee Application

US Forest Service (v05-2014)

OMB 0596-0087 Exp. 06/30/2014

WOODSY OWL^® LICENSING PROGRAM

LICENSEE APPLICATION

Burden Statement

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0596-0087. The time required to complete this information collection is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all its programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-720-2600 (voice and TDD).

To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). USDA is an equal opportunity provider and employer.

GENERAL COMPANY INFORMATION

1. Your Name:      	Title:      
2. Company Name:       Address:       City:       State:       Zip:      
3. Type of Company: Proprietorship Partnership Corporation Subsidiary/Division of       Other       Name of the person who has the authority to sign Licensing Contract (If different from above):      
4. Phone:      
5. Fax:      
6. E-mail:       Website:      
7. Years in Business:       Annual Sales Volume:      
8. Royalty reporting point of contact (if different from above)      
9. Are your products made in USA?       If not, where are they made?       If Sub-Contractors used, please name:      
10. Other Licenses Held:      
11. What are the products you would like us to consider for licensing?
     
     
     
     
     
12. Who is your target market for each of the above products?
     
     
     
     
     
13. What are your channels of distribution for each product?
     
     
     
     
     
14. How does this product promote environmental conservation and Woodsy Owl’s mission?      

FINANCIAL PROPOSAL
15. Sales Forecasts:
Product	Sales Units	Wholesale $/Unit	Gross Sales $	Per Unit Retail Price $
a.      	     	     	     	     
b.      	     	     	     	     
c.      	     	     	     	     
d.      	     	     	     	     
e.      	     	     	     	     
16. Proposed term of License       You may choose 1 to 5 Year(s)
17. Proposed Advance on Royalties:      
18. Proposed Minimum Guarantee on Sales:      
19. Marketing Date (when product(s) will be available at retail):       months
20. Other Information that may be helpful in consideration of this application:       Thank you for completing this Application!

Please return the signed and completed application to [email protected] or fax it to 202.822.5082. If you have any questions, please call Libby Kavoulakis at 202.822.5080.

WOODSY OWL^® LICENSING PROGRAM

LICENSEE APPLICATION APPROVAL FORM

To be completed by Representative for USDA Forest Service:

APPROVAL STATUS:

Approved as submitted

Not approved as submitted

COMMENTS:

     

APPROVED BY: DATE:      

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