Mail completed application and samples to:
NA World Services, PO Box 9999, Van Nuys, CA 91409 USA
Name of prospective vendor:________________________________________________________
Address:________________________________________________________________________
Contact person: ___________________________ Phone: ________________________________

Description of intended use:________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Submit actual pre-production sample(s), for NA World Services' approval. These samples will be kept on file and will be the only item(s) approved for this prospective vendor.

I, the individual representing and authorized to sign for Prospective Vendor, have received a copy of NA Bulletin #3 rev. 6/97 entitled Use of NA Trademarks by Commercial Vendors, have read and understand that document, and agree to abide by all requirements in that Bulletin, including to indemnify and defend NA World Services for any claims brought against it by reason of my use of the NA Trademarks.

You must also include a non refundable annual processing fee of fifty dollars ($50.00) and an annual licensing fee of five hundred dollars ($500.00). The WSO will only process permit requests in January and July.

Name and Signature of the Prospective Vendor:_____________________________________________
Date: _______________________________________________

By: Print name and title:__________________________________________________________________

RESPONSE BY NA World Services
This request was received by NAWS, Inc., has been considered, and the following action taken in response to your request:

Your intended use is approved, expiring on:__________________________
for the marks:__________________________________________________

Your vendor number is (PLEASE USE IN ALL COMMUNICATIONS)
Your intended use is not approved, for the following reasons:_______________________
_________________________________________________________________________

By:_____________________________________ Date:____________________________
NA World Services - Trademark Use Requests. Also enclosed is your vendor permit, which must be displayed where items bearing NA Trademarks are displayed or sold.