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Logo Usage Request Form

*THIS FORM IS FOR INFORMATIONAL PURPOSES ONLY AND IS NOT AN AGREEMENT*

Thank you for your interest in using one of our company logos. Before permission can be granted, please complete the following form which includes your contact information and how you intend to use the requested logo. Your request will then be considered.

Upon approval, we will send you a trademark license agreement to sign and return to us. Once we have received your signed agreement, we will e-mail you the logo in the format you indicate below. Until then, you should not assume that you have an agreement, any license rights or other approvals from First Data Corporation to use the requested logo.

NOTE: All questions must be completed.

Please indicate the urgency of your request:

High (5 to 10 business days) Medium (2 - 4 weeks)

Low (4 +weeks)

Contact Information

Name:* Required Field
Job Title:* Required Field	Company:* Required Field
Phone:* Required Field	Fax:* Required Field
E-mail:* Required Field

To prevent spam please re-enter the first four characters of the telephone*

Corporate Information

Name of company requesting permission:

Street:

City, State, Zip:

Industry:

Current Relationship with First Data

Are you aware of any existing agreement between your company and First Data (or a subsidiary or affiliated company of First Data)?

Yes - Name / Type of agreement:

If you are currently working with an employee of First Data or one of its subsidiaries or affiliated companies, please provide the following for that person:

Name:* Required
Job Title:* Required Field
Phone:* Required Field
E-mail:* Required Field
With which First Data business segment are you working? First Data - USA First Data - International
Are you an existing First Data merchant? Yes No
If yes, what is your merchant ID#?

Logo Request Details

Check all that apply.

	Format	Color
First Data®
STAR®
TeleCheck®
Other:

Usage Details

Describe how you intend to use the logo(s). Please provide a detailed description including, at a minimum, the format (brochure, web site, etc.), type of media (printed, electronic, etc.), country, and audience with which the logo is proposed to be used.

Please indicate the timeframe in which the logo(s) will be used:

Start Date:

End Date:

Approximately how many people will be exposed to the materials displaying the logos(s)?

At this time, can you provide a sample of the materials showing your intended use of your logo(s)?

Yes.

No.