Intellectual Property Request Form

Intellectual Property Request Form
Your Name*

First NameLast Name
Your Company Name (if you are requesting permission on behalf of a company):
Your Position (if you are requesting permission on behalf of a company):
Your Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Type of Intellectual Property Requested:*
Description of Proposed Use:*
Please note that submitting this request does not grant you permission to use the requested intellectual property for the proposed use. We will respond to your request for permission at our earliest opportunity.
Signature
Should be Empty: