Attorney Protection of Your Trademarks - Trademark Questionnaire

Trademark/Service Mark Questionnaire

Desired Service:

	New Application
		Provide Registration Number:
	Maintenance
	Renewal

Country/Countries:

	United States

	Foreign	(Please list countries of interest)

Exact mark to be registered:

(Description of Logo if any)

Full Name of Trademark Owner:

Owner Type (Individual or Corporation or other Entity Type)

Principal Office Address of Owner

City

State

Postal Code

Country

If individual, please provide citizenship:

If Corporation, company, LLC, LLP, etc. please provide Country and State of formation:

If Partnership please provide the following information:

State or Country of Formation

The name of each general partner and country of citizenship (if individual) or state of formation (if legal entity),

If this is a maintenance or renewal application, please advise if there has been a change in ownership of the mark changed since registration

Name and Address of Contact:

Telephone Number of Contact

Fax Number of Contact

Wireless Number of Contact

Email of Contact

Filing Basis:

United States applications must be filed on one or more of the following basis: 1) Use in Commerce; 2) Intent to Use; 3) Foreign application with 6 months home country filing; 4) Foreign registration. Please provide information

Intent to Use Application

Date of First Use anywhere

Date of First Use in Interstate Commerce

Based on Foreign Application

Based on Foreign Registration

Country of Application or Registration

Filing Number or Registration No

Filing Date or Registration Date

Goods and Services Information:

New applications, describe your product or service.

Maintenance or renewal applications, advise if any of the goods or services listed in the registration are not in use.

Maintenance or Renewals:

Country

Registration Number

Registration Date

Additional Information we should know:

PLEASE Complete the questionnaire and return to us so we can prepare the necessary forms to proceed with your application. FAX: 802 425-9061 Email: GTROY@WEBTM.COM