Clark & Bellamy new client trademark information form

Use this form to provide information to Clark & Bellamy for filing a new trademark application. The form provides for separate entry of up to three trademarks. For more trademarks, please repeat the process and complete an additional form.

Trademark Intake Form

Formal Name of the Owner(Required)

The owner and contact person might differ. Identify the owner of the trademark here.

Owner Street Address(Required)

Provide the Domicile and Physical Street Address of the owner. Do not list a PO Box or Mail Drop.

Apartment, suite, etc

You may list the Owner’s PO Box or Mail Drop here if applicable for the mailing address.

City, State, Zip (Owner)(Required)

Email Address (Owner)(Required)

Applicants will enter a separate address for the primary contact person or employee if different than the owner.

Entity Type(Required)

Other Entity Type

State Organized (if LLC/Corporation, etc)

Land Phone Number (Owner)

Mobile Phone Number (Owner)

Fax (Owner)

Contact Person is Same as the Owner?(Required)

Yes

CONTACT INFORMATION

(IF DIFFERENT THAN THE OWNER)

Name of Contact Person

Title of Contact Person

Email Address (Contact)

Land Phone Number (Contact)

Mobile Phone Number (Contact)

Street Address (Contact)

Apartment, suite, etc (Contact)

City, State, Zip (Contact)

TRADEMARK INFORMATION SECTION

This trademark information section repeats to enter three trademarks. Please complete a separate form for the fourth and additional marks.

TRADEMARK TO REGISTER(Required)

Enter the trademark’s word(s) or briefly describe a logo

STYLIZED MARK(Required)

No – words only

Yes – includes graphics or non-text features

If yes, the attorney requests an exact copy of the second mark for filing.

UPLOAD THE STYLIZED MARK

Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.

The preferred format is a black and white or grayscale image between 300px to 900px.

GOODS AND SERVICES(Required)

List of specific goods or services using or intending to use the trademark.

TRADEMARK IN USE(Required)

Yes

Other

Mark “yes” if the owner currently uses the trademark in commerce for all the goods or services listed. Mark “other” if the owner used the mark with some of the goods/services listed. Else, mark no if the owner “intends” to use the mark soon.

DATE OF FIRST USE

Month

Day

Year

Date of first use of the trademark in commerce to identify any of the products or services listed (leave blank if “intent to use”)

ADDITIONAL TRADEMARK(Required)

Yes

If you want to protect another trademark, such as a logo, select “yes” to enter the additional information.

TRADEMARK INFORMATION SECTION

Enter information for the 2nd trademark.

#2 TRADEMARK TO REGISTER(Required)

Enter the trademark’s word(s) or briefly describe a logo

STYLIZED MARK(Required)

No – words only

Yes – includes graphics or non-text features

If yes, the attorney requests an exact copy of the second mark for filing.

UPLOAD THE STYLIZED MARK

Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.

The preferred format is a black and white or grayscale image between 300px to 900px.

GOODS AND SERVICES(Required)

List of specific goods or services using or intending to use the trademark.

TRADEMARK IN USE(Required)

Yes

Other

DATE OF FIRST USE

Month

Day

Year

Date of first use of the trademark in commerce to identify any of the products or services listed (leave blank if “intent to use”)

ADDITIONAL TRADEMARK(Required)

Yes

If you want to protect another trademark, such as a logo, select “yes” to enter the additional information.

TRADEMARK INFORMATION SECTION

Enter information for the 3rd trademark.

#3 TRADEMARK TO REGISTER(Required)

Enter the trademark’s word(s) or briefly describe a logo

STYLIZED MARK(Required)

No – words only

Yes – includes graphics or non-text features

If yes, the attorney requests an exact copy of the second mark for filing.

UPLOAD THE STYLIZED MARK

Accepted file types: jpg, gif, png, pdf, Max. file size: 64 MB.

The preferred format is a black and white or grayscale image between 300px to 900px.

GOODS AND SERVICES(Required)

List of specific goods or services using or intending to use the trademark.

TRADEMARK IN USE(Required)

Yes

Other

DATE OF FIRST USE

Month

Day

Year

Date of first use of the trademark in commerce to identify any of the products or services listed (leave blank if “intent to use”)

This field is hidden when viewing the form

Agreement

Agreement(Required)

Click to Consent

By clicking the Submit button below you electronically agree to Clark & Bellamy, P.C.’s Terms of Service, Privacy Policy, and trademark prosecution Retention and Engagement Terms.