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Intake Form: Meeting With an Attorney to Trademark a Business Name

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This form will help you collect theinformation you need to present to your attorney in order to trademark orservice mark your business name.

Client Information

Contact name:


Position:


Business Name:


Address:



Telephone: ______________ Fax: ______________

Mobile ______________ E-mail: _______________

Business' legal status:

_____ Individual

_____ Partnership

_____ Corporation (type:_____________________ )

If business is a partnership:

Name of each general partner:




If business isa corporation:

State of incorporation:




Description of Use of Mark

What goodswill the mark be used on or in connection with? (The goods should be identified in clear andprecise language, e.g., "computer programs for use by accountants,"or"retail food store services.")




What serviceswill the mark be used in connection with?




In what mannerwill the mark be used on or in connection with goods or services?




On labelsattached to goods?



In advertisements forservices?



Other (describe)?



In interstate commerce?



In commerce between United States and specified foreign country or countries?



What is theclass number(s) of the goods or services you will use the mark in connectionwith?



Dates ofMark's Use

If mark hasbeen used in commerce:

When was the mark first used in commerce?



Whenwas the mark last used in commerce, if not currently in use?



What facts evidence your bona fide,good-faith intent to use mark in commerce?




When do you plan to use mark in commerce?




Other Uses of Mark

Will any otherentity be using mark? ________

What is the entity's name and owners:




What is the entity's address and telephonenumber?




Does this entity control your business, ordoes your business control the entity, with regardto the nature or quality of goods or services in connection with which the markis orwill be used? ________

Has the markever been used and discontinued? ________

If so:




What were the dates and time period ofnonuse?




Describe conditions of nonuse?




Reason for nonuse?




Has there orwill there be an assignment of the mark? ________

Has the markbeen denied registration previously? ________

If yes:




What is the date of the denial?


What were the reasons for denial?




Hasregistration of the mark ever been formally opposed? ________

If yes:




In what type of proceeding (opposition,petition to cancel registration, interference, or judicialproceeding)?


What was the date of the previousapplication(s)?


What is the name and address of the opposingperson or entity?




What was the reason for opposition?




What was the disposition of the proceeding?




What is the possibility of further futureopposition?




Are you awareof any other person or entity who believes that he or she has been or would bedamaged by registration of the mark, such as a competitor using a similar mark? ________

If yes:




What is the name and address of that personor entity?




Has this person ever filed or threatened tofile a petition to cancel registration? ________

Has concurrentregistration of the mark been previously allowed? ________

If yes:




What was the date of previous registration?


Is the registration is still in effect? ________

Who is the owner of other concurrentlyregistered mark?



Is the marknow or has it ever been registered on the supplemental register? ________

If yes:




What is the date of registration?


What was the basis for registration(distinguishing goods or services in commerce for one year,or distinguishing goods or services in commerce and foreign protection requiredfor mark)?




Have youalready applied for federal registration of mark on the basis of intent to use?________

If yes:




What is the date the application was filed?


What is the date the notice of allowance wasissued?


Which particular goods and/or services markhas been used on or in connection with commerce?


What kind of ongoing efforts have you made touse the mark in commerce:

_____ Product or service research ordevelopment?

_____ Market research?

_____ Manufacturing activities?

_____ Promotional activities?

_____ Steps to acquire distributors?

_____ Steps to obtain required governmentalapproval.?

_____ Other, similar activities (describe)




Have youpreviously requested and received extension(s) of time in which to filestatement of use? ________

If so, when?




Next Steps
Contact a qualified business attorney to help you identify
how to best protect your business' intellectual property.
(e.g., Chicago, IL or 60611)

Help Me Find a Do-It-Yourself Solution