Trademark Request Form

Search or Registration of a Prospective Trade-Mark, Service-Mark, Collective-Mark, or Certification-Mark

Please provide us with the following information so that we may better assist you in connection with your trademark needs.

1. Please indicate the precise name and address of the entity which uses or will use the Mark (the "applicant"):

__________________________________________________________

2. Please indicate the full name (including degrees, honorifics, and suffixes) and office title of the official who will execute the application on behalf of the applicant, and contact address:

__________________________________________________________

3. If the Mark consists of or includes words, what is the exact spelling (and punctuation)?

__________________________________________________________

4. Does the Mark include or consist of a specialized logo, stylized text, special coloring, or other pictorial design? ___________ If so, please attach a copy (preferably, black-and-white, camera-ready), if available. Will a sound or particular color be part of this Mark? _________ If so, please describe in detail _________________________________________________________

4. On what goods, or in connection with which services, is the Mark to be used? __________________________________________________________

5. Do you anticipate expanding use of the Mark to other goods or services -- even if not until several years from now? __________ If yes, onto what goods, or into which services, might you consider expanding your use of the Mark (be creative)? __________________________ __________________________________________________________

6. Are there any words, phrases, graphics, packaging, or similar dress, separate from the Mark itself, that you plan to have associated with your Mark? _______ If so, please describe in detail, and attach pictures or photocopies, if available _____________________________ __________________________________________________________

7. Has the Mark already been used in a bona fide transaction of goods or services within a single state? __________ If yes, provide the date of the first sale of goods bearing the Mark, or the date of the first advertisement for services depicting the Mark (assuming you were prepared to offer the services on that date): ___________________________________________________________

8. Has the Mark already been used in a bona fide sale of goods or services across state lines (i.e., "interstate commerce")? If yes, provide the date of the first sale of goods bearing the Mark, or the date of the first advertisement for services depicting the Mark (assuming you were prepared to offer the services on that date): _____________________________ If not, please indicate whether you have a bona fide intent to use the Mark in interstate commerce _____ and provide the approximate date on which such use will begin __________________

9. Is the Mark used on goods imported into the United States from a foreign country? ________ If yes, please provide the date that goods bearing the Mark first entered the United States ____________ and indicate the country of origin ___________________________________________________________

10. Please indicate all means and manners in which the Mark is or will be used (either on the goods or in connection with the services, as applicable) in interstate commerce -- for example, on labels affixed to the goods, on packaging containing the goods, in media advertisements, in sales brochures, etc.: ____________________________________________________________

11. Who do you anticipate will be the groups of people likely to see the Mark in commerce (i.e., who is the likely customer base)? ____________________________________________________________

12. If the application is to be based on a Mark application that has already been filed in another country, please indicate the country, serial number, and filing date of that application, and verify that the Mark and goods of the foreign application are identical to the Mark to be registered in the U.S. ____________________________________________________________ ____________________________________________________________

13. If the application is to be based on a foreign registration, please provide a certified copy of the registration, together with an English translation signed by the translator, and verify below that the Mark and goods of the foreign application are identical to the Mark to be registered in the U.S. ____________________________________________________________ ____________________________________________________________

We strongly recommend that asearch be performed on any and all proposed Marks, before proceedingwith the use or registration of the Mark, in order to judge whetherthe Mark is available. At a minimum, the Federal registrationsshould be searched. In most cases, however, a wider search iswiser. For example, many states maintain registration rolls formarks, which can be searched electronically. Additionally, manycomputer databases of products, services, and companies are availablewhich can be searched inexpensively to help uncover so-called"common-law" marks (unregistered marks that, throughuse and market recognition, are entitled to limited protection).Finally, if you expect to use the Mark in one or more non-U.S.markets, the search should include registrations in those markets.If you prefer, we have found a company who will perform thesesearches, but the company will charge you about $350. The followingquestions will aid us in performing a search for you.

14. Please indicate what kind of search you would like NCI TTC to perform:

____ (a) No search by NCI TTC; please use the searching company (CAN No. __________)

____ (b) Minimal search, Federal registrations only

____ (c) Standard search, including Federal and State registrations, and common-law marks

____ (d) Extended search, including the Standard search and foreign registrations [(c) or (d) is strongly recommended]

15. If the Mark is now in use, please provide five specimens bearing the Mark ("specimens" includes actual goods, or advertisements for services) as actually used in commerce.

16. Are you presently using any registered marks that are similar to the proposed Mark? _______ If so, please specify the mark, along with any identifying information (such as application or registration numbers), and attach samples if available: ____________________________ ______________________________________________________________

17. Are you aware of anyone else who is presently using any marks, registered or not, that are similar to the proposed Mark? ______ If so, please specify these other marks, along with any identifying information (such as application or registration numbers), and attach samples if available: ______________________________________________________________ ______________________________________________________________

Thank you for completing this questionnaire. The information should facilitate our efforts to fulfill your Mark request. If you have any questions about this form, or about the process of applying for a mark-registration, please contact our office at (301) 496-0477.