Owner of the mark: IndividualCompany-Owner

Owner of the mark

Entity Name

State where entity formed

Entity Type (choose ONE)

Mailing Address

Phone Number

Email Address (all acknowledgments will be sent to THIS email address)

Trademark Information (spelling, format, if(or) logo - please attach a black and white image of a logo in jpeg/pdf format)

Goods or/and Services covered by the Mark

Date when the mark was First Used

Date when the mark was First Used in Commerce

Has the Mark been Filed in any other Country? YesNo

List the countries and dates


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