Trademark Intake Form

Applicant/Owner of Mark Information

Individual or Company Name that you want to be listed as the owner of your Trademark application

Company Name or Individual (Owner)

Owner of Mark

If the owner listed above is a company, please provide the Company Representative and title of the individual authorized to act on its behalf.

First Name

Last Name

Title

Domicile Address

(The USPTO requires a domicile address for a U.S. entity, not a mailing address. The domicile address can be a foreign address for a U.S. entity. ‘Domicile’ is the principal address where a person resides, so it cannot be a P.O. Box, C/O address, or commercial mailbox. This information will NOT be publicly displayed as part of your application unless it is the same as the mailing address.)

Physical Address

Will be the public address, if a mailing address is not provided.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

Country

(###)

###

####

Website Address

(optional)

http://

Mailing Address

If different from the Domicile Address – Please note, the mailing address listed on the trademark application is public information

Address

Public address, if provided.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Legal Entity Information (required if the applicant is a company, not required if the applicant is an individual)

Company Name

Type of Business

Type of Services or Products

State/Country of Incorporation

Mark Information

Word Mark, Logo Mark, or combined Word & Logo Mark

Standard Character Mark

If the mark is a standard character mark, type in the characters below

Combined Word & Logo Mark

Type the characters of the combined mark and add a file of the image

Description of goods and services for which the mark is or will be used:

Have you have conducted any searches or research on the brand name you wish to register?

Yes

Are there any existing trademarks or applications related to your brand?

Yes

I do not know

Has the mark already been used in commerce?

If so, please provide the following information

Yes

Date of First Use

Anywhere

YYYY

Date of First Use in Commerce

YYYY

To begin the trademark process, please fill out the following form.

Trademark Intake Form

Thank you! ICS-P Online will perform a conflict check on your mark and get back to you shortly!

ICSP Online