1. Applicant's Name__________
2. Applicant is (Type of Entity): a. Individual
d. Limited Liability company
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,
Partnerships: The signer must be a General Partner
Full Legal Name _____________
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"
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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