Prepared By: [Your Name]

Date: [Month Day, Year]

1. Type of Intellectual Property (Select one):

• Trademark

•  Copyright

•  Patent

•  Trade Secret

•  Other: ________________

2. Description of Intellectual Property:

Title/Name:

Registration Number (if applicable):

Detailed Description:

1. Purpose of Use:

• Commercial Advertising

•  Educational

•  Promotional Campaigns

•  Digital Marketing

•  Other: ________________

2. Duration of Use:

Start Date:

End Date: 

Total Duration:

3. Geographic Scope of Use:

• Local

•  National

•  International

• Specific Regions: ______________________

1. Fee Structure:

One-time Fee: 

Recurring Fee: 

Royalties: 

Other Fees:

2. Payment Terms:

Initial Payment Due Date:

Recurring Payment Schedule: