Request For Permission to Use Google Brand Features

Print this form and fax your request to Google's Marketing Department at 650-618-1805 or mail it to:

Google Marketing Department Attn: Permission Request 2400 Bayshore Parkway Mt. View, CA 94043

Be sure to include:

?? The exact name and title of the organization and/or person requesting permission and contact information including e-mail, phone, fax, and mailing address. If the person submitting the request is not the ultimate user of the Brand Features, please let us know that and include all required information for both the requestor and the end user.

?? A layout or other sample that clearly shows how the Google Brand Features will be used. ?? Information for the materials in which the Brand Features will be used. This includes the

following: o Type of media (e.g., book, web site, video, etc) o URL for the medium if the medium is a web site -- the title otherwise o Detailed description of the nature and content of the materials o How the materials will be distributed (including geographic locations, number of copies,

timeframe, etc) o Name of all authors and editors for the materials

I acknowledge that I have reviewed the Google Brand Features Guidelines and the Google Brand Features Terms and Conditions, which are hereby incorporated by reference, and which I and my organization agree will exclusively govern any use of the Google Brand Features pursuant to this request.

Signed: _______________________________________ Name: _______________________________________ Title: _______________________________________ Organization: _______________________________________ Email address: _______________________________________ Date: _______________________________________

- - - - - - GOOGLE CORPORATE USE - - - - - - ___Approved ____ Not Approved Reason: _______________________________________________________ Name Google Inc. Date Title: _______________________________