I, [name of applicant], do hereby apply for a license to
display the trademark of [association], “[trademark] ”
at my place of business located at [address] , in
the City of , State of .

That this application is in accordance with the
regulations of the [trade association].

I am cognizant of the regulations of [trade association]
that govern the display of said trademark and the manner
of conducting business, and I agree to abide by such
regulations at all times.

Dated:_______________ ______________________________
[Signature]