Venice Sign Intake Form

The VENICE Sign is a federally registered trademark of the Venice Chamber of Commerce. To include the VENICE Sign in any form of published media an agreement is needed. To begin the process please complete and submit this form. We will then follow up to discuss how best to proceed.

First and Last Name

Email Address

Phone Number

Company information: entire company name and address; type of entity and where organized [e.g., California corporation, Delaware limited liability company]

Contact information for the person/company that will have the final determination on how the sign is to be used.

Name and title of person who will sign license on behalf of licensee.

What are their plans for using the sign, distribution area, timeline? (If a television commercial: how long (approximately) will sign be featured and how long is the commercial in total? In what media will commercial air? Television, internet? How many different commercials will show the sign? Term of use: how long do they want to use sign for?)

Any other media, photographs, print, billboards, newspaper/magazine ads, etc? (How many billboards? How many different newspapers/magazines? What is circulation of magazine/newspaper? Geographic limitations?)

Do they have a form release/license that they want to send over, or do they want us to prepare the license?

Is there any other relevant information you wish to offer?

Preferred Contact? Preferred Contact? phone email

15 + 14 =