Northeastern University Licensing Online Approval Form

Organization/Department

Are you a registered student group?
Yes No

Contact

Phone

E-mail

Product Type

Quantity

Purpose of Merchandise

Product will be (check all that apply):
Sold to the general public
Given to members only
Sold to members only
Other

Proceeds will be used for (check one):
Education programs
Support of philanthropy
Social events (description)

Other

Name of licensed manufacturer:

Contact

Phone

Email