Prior to searching or applying for registration, the applicant will need to describe in detail the goods and services to be identified with the mark. We have not yet searched the marks, reviewed any legal issues for you, nor rendered any legal services. We will proceed only if we are retained as outlined herein.

1.  MARK: _________________________________________ (if other than a standard character mark, please attach an accurate example of mark in black and white that does not exceed 4" x 4", unless you would like to claim color as part of the mark.)

2.  ALL GOODS AND SERVICES USED/TO BE USED WITH THE MARK - DESCRIBE IN DETAIL:

3.  HAS THE MARK YET BEEN USED? ____________________

• If YES, please provide date of first use anywhere_________
• Date of first use in interstate commerce  _______________

4.  PLEASE LIST YOUR OTHER EXISTING REGISTRATIONS OR APPLICATIONS,  IF ANY, FOR THIS MARK OR A RELATED MARK IN THE U.S. OR ANY FOREIGN COUNTRY:

5.  STATE EXACT NAME OF PERSON OR ENTITY WHO WILL BE THE APPLICANT FOR THIS MARK: ___________________

6.  IF A CORPORATION, PLEASE PROVIDE THE STATE OF INCORPORATION: _______________

7.  ADDRESS OF APPLICANT: ______________________________________________________

8.   EMAIL ADDRESS FOR APPLICANT'S CONTACT PERSON(S): ________________________________

9.   TELEPHONE: _________________  FACSIMILE: ________________

10.  DO YOU REQUEST A SEARCH OF THIS MARK?:

                      _____ YES:   Full search ________

                      _____ YES:   Federal only _______

                      _____  NO SEARCH REQUESTED

11.  ARE YOU REQUESTING FILING OR SEARCHING IN ANY OTHER COUNTRY BESIDES THE U.S.? ____

PLEASE SIGN HERE:

__________________________________ (signature)

__________________________________ (print name and title)

__________________________________ (today's date)