1. 1.Instructions:  Please print, complete and return by fax, email or regular mail

  2. 2.Proposed mark:  

  3. 3.Is the mark a logo or stylized words?  

  4. 4.Alternate marks:

  5. 5.Owner’s name:

  6. 6.If owner is a corporation or LLC, please provide state of formation and date  of formation: 

  7. 7.Owner’s address: 

  8. 8.Owner’s telephone: 

  9. 9.Owner’s email address: 

  10. 10.Email a .jpg or send me an illustration of your mark including logo, words and phrases that make up the mark.

  11. 11.Describe the exact product, service or both that your mark will identify.

  12. 12.Explain the manner in which the mark is used in connection with your product and/or service  (e.g. printed on goods, labels or packaging, used in advertising used on letterhead or business cards, etc.): 

  13. 13.Provide a sample of the items on which the mark appears.  This may be your web page which advertises your services or a web page on which your products are available for purchase.   In this case, please provide the link to your site:

  14. You may also submit advertisements, brochures, photographs of signs or other such materials containing the mark. For goods you may submit labels attached to the goods, containers, or photographs showing the mark as it is used on the goods.  You may also attach a .jpg showing how the mark is used (e.g. photograph of the product bearing the mark.) 

  15. 14.Do you have any plans to use the mark on products or services that have not already been mentioned above?  If so, which products or services?

  16. 15.When was the first date of sale of your product or service using this name?

  17. 16.When was the first date of sale across state lines or internationally, if any? 

  18. Please note that the use across state lines must be in the ordinary course of business and not just to reserve the mark.  If you have not yet used the mark in interstate commerce but intend to use it in the future, you may file an intent-to-use application.  This will require an additional filing fee at the time that you actually begin use of the mark.  In addition, if you do not use the mark within 6 months of the time you receive your Notice of Allowance to use the mark (which takes 6-9 months), you will need to file a request for an extension and pay another filing fee for every such extension.

  19. 17.Will the product or service by sold in foreign countries? 

  20. 18.Would you like information on registering in foreign countries?

If you have any questions or need assistance in responding to the questions above, please contact me.

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