NOTE: This form is not intended as legal advice. Nor is it a solicitation for engagement. Rather, this
form is supplied as a convenience for those seeking legal assistance from any trademark attorney.

U.S. FEDERAL TRADEMARK APPLICATION INTAKE DATA

Instructions: Provide the following information and promptly confer with your attorney
to develop a proper course of action.

1. What is the mark? ______________________________________________
______________________________________________________________
______________________________________________________________
Provide several specimens of the mark in use or as intended to be used, if available.

2. Has a trademark search been conducted within the past 60 days? Yes [ ], No [ ].
Include a copy of any search results, and details of any similar marks known to be
used in commerce.
3. Applicant’s formal name: ________________________________________
4. Applicant’s business address: ____________________________________
tel: ___________________________________________________________
fax: _______________________ Email ____________________________
5. Applicant’s Entity/Citizenship: Individual [ ], Corporation [ ], Other [ ]
_______________________________________________________________
State/country of citizenship or incorporation _____________________________
6. Broad description of the goods an/or services provided under the mark:
_______________________________________________________________
_______________________________________________________________
7. Describe how the mark is used: ____________________________________
_______________________________________________________________
8. First date the mark was used anywhere by the applicant: _________________
9. First date the mark was used in commerce, in the United States: ___________
10. Cite any prior non-U.S. trademark registrations or applications for the same mark:
Country: _____________ Date of filing: _______ Reg. no. _________________