1. What name do you want to use on the application? _________________________

________________________________________________________________________

________________________________________________________________________

2. Is there more than one owner?

______   Yes______   No

If you answered yes, who are they?  ____________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

3. What address should be used on the application?   

____________________________________________________
Street address

____________________________________________________
Street address

____________________________________________________
City     State   Zip

If there are multiple addresses, write them on the back of this sheet.

4. What kind of entity is the applicant?

_____   An individual_____   A partnership_____   A corporation

Other: ____________________________________________________________

5. Describe the products or services that will carry your mark. _________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

6. How do you describe your mark?Pretend you have it in front of you and you're describing it to a colleague over the telephone. Write down what you would say. Include the colors you want to use, a special way of using a particular word, what any graphic symbol looks like and where it is placed.

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

7. Are you sure that you have decided on the final version of the mark?

______Yes______No

8. Are you planning to seek a trademark on a particular color you have used? (It is difficult, but possible to do. ) While the color remains in the public domain, nobody else would be able to use that color for the same kind of product.

______Yes______No

9. What kind of product will use the mark? Choose from the following list (the services are listed after the products).

______   Chemicals

______   Paints

______   Cosmetics

______   Cleaning preparations

______   Lubricants and fuels

______   Pharmaceuticals

______   Metal goods

______   Machinery

______   Hand tools

______   Electrical apparatus

______   Scientific apparatus

______   Medical apparatus

______   Environmental control apparatus

______   Vehicles

______   Firearms

______   Jewelry

______   Musical instruments

______   Paper goods or printed matter

______   Rubber goods

______   Leather goods

______   Non-metallic building materials

______   Furniture

______   Housewares and glass

______   Cords and fibers

______   Yarns and threads

______   Fabric

______   Clothing

______   Fancy goods

______   Floor coverings

______   Toys and sporting goods

______   Meats and processed foods

______   Staple foods

______   Natural agricultural products

______   Light beverages

______   Wines and spirits

______   Smokers' articles

______   Advertising and business

______   Insurance and financial services

______   Construction and repair

______   Communication

______   Transportation and storage

______   Education and entertainment

______   Miscellaneous

10. Are you already using your mark in commerce?

______Yes______No

11. When was your mark first used?   ______________________________________

12. If your first use was purely local and conducted only within your state, when was your mark first used in interstate commerce?   

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

13. Have you used your mark for business between your state and another country or a territory of the United States?

______Yes______No

14. How is the mark used?

______  It is affixed directly on the product.

______  It is on a label attached to the product.

______  It is on letterhead, mailing labels, business cards, advertisements or signs.

15. If you are not already using your mark, do you plan to use it within the next six months?

______Yes______No