1. Name and Residency/Citizenship Information

Client or Client Contact’s individual name and state/country of residency/citizenship: *

Business entity name, type, and state/country of organization (if applicable):

Who would you like to be listed as the owner of your trademark registration: you as an individual, or your business as an entity?

2. Contact Information

Email address: *

Phone number: *

Mailing address (please indicate business or personal): *

Please note that this address will be publicly listed with your trademark application. If you would prefer to keep that address private, please state so here and the firm will list its own address and only submit the above address for the required non-public domicile address.

If your business uses a virtual mail address or PO Box-type address, please also provide a physical address that can be submitted for the required non-public domicile address:

3. Trademark Details

What is the word or phrase you wish to register as a trademark? *

Does your trademark have a particular design you wish to protect?

Yes

If so, please attach a copy of the design file.

4. Goods and Services

Please provide a detailed description of the goods or services you intend to provide in association with the trademark.

***Note: Trademark filing fees are determined based on the number of classes of goods/services in the application. Additional filing fees may be required if the trademark team determines that you are providing goods and services in more classes than originally anticipated.

For goods and services whose purpose is self-explanatory, please list the type. *

For example, “clothing” types include shirts and pants, while “cleaning service” types include house cleaning and lab equipment cleaning:

For goods and services whose use requires a little more explanation, please provide more details so we can understand exactly what your good/service is and does.

For example, if you’re providing software, please let us know what that software does (allows users to order food; optimizes warehouse organization) and how the consumer accesses it (is it downloadable or is it accessible via an online platform?).

Have you started selling or providing the goods/services with the trademark yet?

Yes

If so, please provide links to or photos of the goods/services and the date of first sale of the good/service.

Website or Image URL

Date of first sale

5. International Trademark Registration

Are you interested in applying for a trademark in any other countries besides the United States?

Yes

In what country would you like to register the trademark?