Merchandise Licensing Inquiry

Please use the form below to tell us about your merchandise program.
Fields with an * must be filled out before submitting the form to us.

*NAME:
*COMPANY:
*ADDRESS:
*CITY:
*STATE:
*ZIP CODE:
*PHONE:
*E-MAIL:
FAX:

	*Client(s) you are interested in:

	*Specify Product Medium(s):

	*Advertising Budget:

	*Distribution of Products:
	Consumer Sales Direct Response Internet
	Premiums Other:

	*Territory(ies) of Distribution:

	*Desired Term (i.e. 2 year, 1 year, 6 month, etc.):

	*Are any other celebrities/trademarks being utilized in the campaign, or are there any additional comments?:


	We will review your submission and contact you via telephone call or email as soon as possible.