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1. Applicant's Name__________
2. Applicant is (Type of Entity): a. Individual
b. Partnership
c. Corporation
d. Limited Liability company
e. Other
If the application is an individual, please provide the country of citizenship.
Corporations or partnerships please indicate state and country of Incorporation/Organization
3. Applicant's physical address:___________________
4. Person signing the TM Application:
Individuals: The person signing the application must be the owner of
the trademark and must be an Adult.
Corporation: The signer must be a Corporate Office (President,
Secretary, etc.)
Partnerships: The signer must be a General Partner
Full Legal Name _____________
Title _____________
Telephone Number _____________
7. Status of Trademark
( )The mark is currently in use and has been in use since________
( ) The mark has never been used by applicant but "Intends to Use"
the Mark
8. Interstate Use of Trademark
Interstate use of a mark is use between two or more state or between the
U.S. and a foreign government.
( ) Application has used the mark in interstate commerce on ________
( ) Application has not used the mark in interstate commerce but intends
to do so
( ) Application has not used the mark in interstate commerce and does
not intend to do so
9. Current Trademark Registrations:
If this mark is currently registered with any state or foreign country,
please indicate the state or country. _____________________
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