Logo Application

Contact name____________________________________________

Company name___________________________________________

Address_________________________________________________

________________________________________________________

Phone_________________________ Fax______________________

E-mail___________________________________________________

Full description of each product on which you are requesting to use the Worthington Bicentennial Logo: (please feel free to include attachments to this form)







Description of company, business or organization:





Please circle one:            Non-profit organization             For-profit organization

If you are a non-profit organization, do you plan to raise money through the sale of Bicentennial logo products? (please circle one)        Yes        No

What is your proposed method of distribution and target markets?






Is there any further information that you would like to provide that may assist us in the review of your application?

Please return completed applications to:
Anne Brown
City of Worthington
6550 N. High Street
Worthington, OH  43085
fax- 614-436-5966
email - brown@ci.worthington.oh.us