[Date]

[Addressee]

Dear [Name]:

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 [city], State of [state].

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:


 _________________________________________
              [Clearly print name after signature]