Trademark Registration Application

TRADEMARK REGISTRATION APPLICATION

This Trademark Registration Application (the "Application") is executed as of by and between Applicant Name: and Authorized Representative: .

RECITALS

WHEREAS, Applicant claims ownership of the trademark set forth in this Application (the "Mark") and seeks to obtain federal registration for such Mark in connection with the goods and/or services identified herein; and

WHEREAS, Authorized Representative is duly authorized to prepare, file and prosecute trademark applications on behalf of Applicant and to execute declarations, assignments and other documents necessary to obtain registration; and

WHEREAS, Applicant and Authorized Representative desire to set forth the information and declarations necessary to support the filing and prosecution of this Application.

NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein, Applicant and Authorized Representative agree as follows:

1. DEFINITIONS

For purposes of this Application, "Applicant" means the person or entity identified above as applicant and "Mark" means the trademark or service mark described in Section 3 below. Terms not otherwise defined shall have the meanings customarily ascribed to them in U.S. federal trademark practice.

2. APPLICANT INFORMATION

3. MARK DETAILS

4. GOODS & SERVICES

5. PRIORITY & DATES

Date of First Use in Commerce:   Date of First Use Anywhere:

6. SPECIMEN

Specimen Attached: Yes   If Yes, specify exhibit identifier:

7. DECLARATIONS, REPRESENTATIONS AND WARRANTIES

Applicant expressly represents, warrants and declares that: (a) Applicant is the owner of the Mark or has the right to use and seek registration of the Mark; (b) the information contained in this Application is true and correct to the best of Applicant's knowledge and belief; (c) to the extent the Application is filed on the basis of use in commerce, the Mark is in actual use in commerce as of the dates stated; and (d) Applicant understands that knowingly submitting false information in a trademark application may subject Applicant to civil and criminal penalties.

Applicant authorizes Authorized Representative to prosecute the Application, sign declarations, execute assignments or other instruments relative to the subject matter of this Application, and to receive correspondence relating to the Application.

8. ASSIGNMENT / OWNERSHIP

Applicant warrants that there are no outstanding assignments, licenses, liens, or encumbrances affecting the rights to the Mark except as disclosed in this Application. Applicant will record and provide copies of any written assignments or recorded transfers promptly upon request of Authorized Representative for filing or prosecution purposes.

9. FEES

Applicant agrees to pay all filing, prosecution, maintenance and other government or professional fees arising from or related to the Application in accordance with separate billing arrangements, and acknowledges that failure to timely pay required fees may result in abandonment or loss of rights.

10. NOTICES

Notices shall be in writing and shall be deemed effective upon personal delivery, confirmed facsimile transmission, confirmed electronic transmission, or three days after deposit in the U.S. mail, postage prepaid, addressed to the respective party at the address provided herein or at such other address as a party may designate by written notice.

11. AMENDMENT; WAIVER; COUNTERPARTS

This Application may be amended only by a writing signed by both Applicant and Authorized Representative. No waiver of any provision shall be effective unless in writing signed by the party granting the waiver. This Application may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument.

12. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

This Application shall be governed by and construed in accordance with the laws of the jurisdiction of Applicant's principal place of business, without regard to principles of conflicts of law. This Application constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings and representations. If any provision of this Application is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.

13. CERTIFICATION

Applicant hereby certifies, under penalty of perjury, that the facts set forth in this Application are true and correct and that Applicant has a bona fide intention to use the Mark in commerce with respect to the goods and/or services identified herein (if the Application is filed on an intent-to-use basis), or that the Mark is in lawful use in commerce as stated (if filed on a use basis). Applicant further authorizes Authorized Representative to sign any declarations or other documents required by the applicable trademark authority on Applicant's behalf.

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