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Monthly Activity & Royalty Report
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Contact Information
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FIRST NAME
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Billing Email
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Today's Date
For the Month Ended
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Select a Month
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List
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Date
Product Delivered
Quantity
Cost Per Quantity
Total Amount (In USD)
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Total Sales On Royalty Revenue ONLY (In USD):
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10% Royalty Due To Licensor (In USD):
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Total Non Royalty Revenue (In USD):
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Consent
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I hereby certify that the information set forth on this statement is true and complete as of the date specific above.
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