BLISS HOUSE, INC.

TRADEMARK LICENSE APPLICATION

Thank you for your interest in Bliss House trademark licensing.  This form allows us to get to know your company better so we  ask that you please answer these questions as completely as possible. Submit a rough marketing plan, your catalogs, including price lists, brochures, promotional materials, etc. and samples of your products most similar to those products proposed herein to:  Bliss House, 655 Longmeadow St., Longmeadow,, MA  01106-2215. Please don't hesitate to call 413-565-2205 (or email us at blisshouse@aol.com) if you have any questions or need assistance, as the more complete this application, the more quickly we are able to get an answer.

 1. Company Data:

Company Name: _____________________________________________________

Other Names Used (dba's or aka's): _______________________________________

Address:___________________________________________________________

City:_____________________________ State:______________ Zip:_________

Phone:________________ Fax:______________  Email:____________________

Primary Contact Person: _____________________________________________

Title:_______________________________ Social Security #________________

Additional  Contact Person: __________________________________________

Title:____________________________________________________________

Addresses of Other Locations:________________________________________

 _______________________________________________________________

Years in Business:_____________ Private:_______________Public:__________

 2. Products/Marks:

2a. List product categories in which you are engaged or will be entering.  Sales, rank 

and market share in the categories you are proposing would be very helpful.

 _______________________________________________________________

_______________________________________________________________

2b. Identify each trademark/service mark you wish to use and with which product: _______________________________________________________________

_______________________________________________________________

 3.  Company's Annual Gross Sales Volume   (Most recent three years)

 2000                              2001                           2002

$________                  $_______                  $_______

4a. Company's Annual Advertising/Promotion Budget   (Most recent three years)

  2000                              2001                           2002

$________                  $_______                  $_______

 4b. Describe scope and schedule for advertising of proposed products herein.

_________________________________________________________________

_________________________________________________________________

 5. Schedule:

5a. List proposed products and their introductory dates over a three year period. _________________________________________________________________

_________________________________________________________________

_________________________________________________________________

5b. Proposed schedule for the stages requiring approval: (i) rough concepts, (ii) prototype, (iii) final art, (iv) pre-production (v) packaging, (vi) consumer and/or trade advertising, (vii) PR, (viii) catalog/sell sheets, (ix) production samples. __________________________________________________________________

__________________________________________________________________

5c. Artwork requirements, if any (silk screen, sculptured, etched, 4-color printed, etc.) __________________________________________________________________

__________________________________________________________________

 6. Forecast: (NOTE: -- THIS MUST BE COMPLETED IN ORDER TO BE CONSIDERED)

List anticipated sales by product by year by territory. List selling price to the trade for each product.

___________________________________________________________________

___________________________________________________________________

 7. Manufacturing/Distribution:

7a.  Describe each of your current manufacturing and distribution facilities and/or capabilities. Please indicate whether owned factories or outside suppliers. ___________________________________________________________________

___________________________________________________________________

7b. Describe the percentage of your sales by countries: ___________________________________________________________________

___________________________________________________________________

 8. Sales Organization:

Describe your sales organization:  How many staff sales personnel, number of outside reps. ________________________________ ___________________________________

___________________________________________________________________

 1. Account Type and Firm Name: _________________________________________

Buyer:____________________________________________ Phone:____________

Address:_______________________________________  Estimated Percent:______

2. Account Type and Firm Name: _________________________________________

Buyer:_________________________________________ Phone:______________

Address:___________________________________ Estimated Percent:_________

3. Account Type and Firm Name: ________________________________________

Buyer:________________________________________ Phone:_______________

Address:____________________________________ Estimated Percent:________

4. Account Type and Firm Name: ________________________________________

Buyer:________________________________________ Phone:_______________

Address:____________________________________ Estimated Percent:________

5. Account Type and Firm Name: ________________________________________

Buyer:_______________________________________  Phone:_______________

Address:____________________________________  Estimated Percent:_______

 10. Identify your current product liability carrier(s) and describe the types and limits of each coverage.

_________________________________________________________________

 CREDIT REFERENCES: (MANDATORY)

11. Identify the following credit information on your company: Company's state of incorporation: ______________________________________________________

Bank reference:

 Firm  Name:________________________________________________________

Address:__________________________________________________________

Contact Person:__________________________________ Phone: _____________

 Credit References:

1. Firm  Name: ______________________________________________________

Address:__________________________________________________________

Contact Person: _________________________________ Phone:______________

 2. Firm  Name: ______________________________________________________

Address:__________________________________________________________

Contact Person: _________________________________ Phone: _____________

12. Please attach a current Dun & Bradstreet on your company (Mandatory).

13. Identify any current trademark licenses with Bliss House: ___________________

_________________________________________________________________

Please add or enclose any other information you feel will be helpful in our understanding of your company.  If additional space is needed to complete this form, please attach pages referencing the particular item number.  Thank you for your interest.

 Submitted by:____________________________ Accepted by: ________________

(Print name)______________________________ Date: ______________________

Unaccepted by: ___________________________Title: ______________________

(Print Name)______________________________ Date: _____________________

Reason: ___________________________________________________________

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