Trademark Intake Form

Full Name *

Email *

Phone *

Mailing Address *

What is the name of your trademark? *

Is this a design mark? *

If yes, please attach a high resolution image of the design in black and white

Will the trademark be owned by a business or an individual? *

If an individual, please provide their full name

If a business, please select the entity type

If other, please specify

State of Organization *

Legal Name of Entity *

Principal Business Address (this must be a physical residence or business address, it cannot be a PO Box or postal annex. We can keep your personal address private if needed; if so, include the consumer facing address and your private residence) *

Please list the exact goods and/or services you wish to protect. For example, t-shirt; leather handbag; downloadable software; website; retail store services *

If you have started using the mark in interstate commerce, what is the exact date of first use? For goods, this is the first date when you sold goods over state lines; for services, this is the date when you first provided your services across state lines); if you have not yet started using the mark, type N/A *

Please provide your website URL, and/or attach a .jpeg image of the mark being used in commerce in connection with your goods/services.

Mark being used in commerce

In what country would you like to register the trademark? *

Do you have any customers, distributors, or licensees who use your trademark?

Do you need assistance licensing or marketing your goods/services?

Will you need a new distributor? If yes, when?