Application Trademark United States Patent and Trademark Office

Trademark Questionnaire

Personal Information

Applicant’s name:

Applicant is a: individual citizenship:

corporation state of incorporation:

partnership name and citizenship of general/managing partner:

a limited liability company name and citizenship of general/managing member:

Who is authorized to sign the application and other legal documents?

Address to be used on application:

Phone number:   Alternate phone number:   Email:

If there are multiple addresses, write them on a separate sheet.

Countries where you do business:

The Mark

Please describe the mark:

Have you decided on the final version of the mark? Yes No

Are you already using your mark in commerce? Yes No

If so, when was your mark first used?

Please state whether you have documentary or other evidence of this date and, if so, the form of this evidence. If the mark is associated with separate goods or services, please provide dates relevant to use of the mark with each specific good or service.

Have you used your mark for business between your state and: another state, another country or a territory of the United States? Yes No

If so, when was your mark first used for business between your state and: another state, another country or a territory of the United States?

If there were any earlier commercial uses within a single state, what was that date?

Will the mark be used outside the U.S. Yes No If so, when? For what goods or services?

Have you applied for or been issued a registration in another country? Yes No

If so, in what country and what is/are the application and/or registration number(s)?

If you are not already using your mark, do you plan to use it within the next six months? Yes No

Describe the products or services that will carry your mark.

Goods/Services categories:

Manner in which mark has been or will be used in connection with goods or services, e.g.:

Has the mark been used commercially in connection with either goods and/or services? Yes No

If yes, for what goods and/or services? If no, what is the anticipated date it will be used?

Will the mark appear in logo or design form? Yes No

If so, please attach a high quality copy of the logo or design.

Will any other marks, slogans, designs or distinctive packaging be used with the mark? Yes No

If so, please describe in detail:

Please attach any actual or proposed advertisements, brochures, handbills, or packaging design.

Have you ever conducted a professional trademark search to determine the availability of the mark? Yes No

If yes, please attach a copy of the trademark search report.

Have there been any periods of time when the mark wasn’t used? Yes No

If yes:

Dates of nonuse: Reasons for nonuse:

Please provide a detailed description of each anticipated future development, enhancement, modification, and improvement which may be incorporated into the mark:

Is any portion, component, or element of this trademark not original to the owner of the mark? Yes No

If yes, describe in detail each such portion, component, and element and identify the person who originated each such portion, component, or element:

Other Uses

Do you know of any other person or organization using same or similar mark? Yes No

If yes:

Identity of other user:

Type of goods or services for which other user uses mark:

Date of first use by other user:

Geographic area of use by other user:

Has the other user has registered the mark? Yes No If yes, where?

Legal Process

Will any other person or entity use the mark in the future? Yes No

If yes:

Identity of persons or entities (including, if possible, addresses and phone numbers):

Your relationship to other persons or entities:

Do you intend to sell or license the use of the mark to unrelated entities? Yes No

Do you have prior registrations or attempts at registration of mark? Yes No

If yes:

Dates of prior applications:

Location of prior applications:

Current status or disposition of prior applications:

Do you intend to obtain one or more foreign trademark application? Yes No

Have you signed any documents, agreements, or statements with anyone which restrict in any manner your use or ownership of the mark? Yes No

Are you under any duty, by written contract or otherwise, to assign, license, convey, or transfer this mark, or any right you might possess in this mark, or covering this mark in any manner, to any other person, governmental agency, or business concern? Yes No

If yes, describe:

If you have any questions, observations, or concerns regarding your rights in this mark, the documentation process, trademark laws or regulations, the trademark process, or any other related matter which you wish to discuss, please state: