Manufacturing Authorization Application
Application Type:  

Company Information
Company Name:  
Business Type:  
Phone:   Fax:   Email:  
Company Address:  
City:   State:   Zipcode:  
Company Website:  

Primary Contact
Name:   Title:  
Phone:   Fax:   Email:  
Address:  
City:   State:   Zipcode:  

Marketing Contact
Name:   Title:  
Phone:   Fax:   Email:  

Royalty Contact
Name:   Title:  
Phone:   Fax:   Email:  

Other Information
Please list all product(s) you intend to manufacture using Mothwing™ patterns.
Please enter one per line and include the product name, and the projected retail price.

Projected product(s) retail price:  
Patterns desired:  
Type of decoration or fabric desired:  
Name of current decorator or fabric supplier:  
Territory desired:  
Distribution:  

Submission Requirements

The Manufacturing Authorization Application should be completed in its entirety and submitted with the following materials to Licensing Department via mail to 4049 Pennsylvania Ave, Suite 201, Kansas City, MO 64111:

» Proper request to receive a manufacturing authorization on company letterhead
» Listing of all products to be decorated in MOTHWING™ pattern(s)
» Product sample of each item (products will not be returned)
» 2 Company catalogs or brochures
» 2 Photos of each item (if a catalog or brochure is not available).