Legal services for technology-based companies

_____________________________________________________________________________________ Ascentage Law, PLLC One Broadway, 14th Floor, Kendall Square, Cambridge, MA 02142 USA

TEL: +1.617.475.1603 www.ascentagelaw.com FAX: +1.617.401.3706

Page 1 of 3

TRADEMARK APPLICATION QUESTIONNAIRE

ALL INFORMATION PROVIDED IS HELD IN STRICT CONFIDENCE

Name:

Address:

City:

State: Zip:

Phone: Fax:

Email: Trademark Description

1. Does your mark contain a logo, stylized letters, or design elements?

Yes No 2. Is your mark composed only of word(s), letter(s), number(s), or any combination (no design

elements)?

Yes No 3. Specify the word(s), letter(s), number(s), or any combination that are contained in your mark

or write N/A if none:

4. Describe in words the design elements for your mark if applicable, or write N/A if none:

5. Describe the colors of your work that you wish to claim as a feature of the mark, if

applicable:

6. Please attach a sample of your logo (in color if you want to protect that as a feature).

Legal services for technology-based companies

_____________________________________________________________________________________ Ascentage Law, PLLC One Broadway, 14th Floor, Kendall Square, Cambridge, MA 02142 USA

TEL: +1.617.475.1603 www.ascentagelaw.com FAX: +1.617.401.3706

Page 2 of 3

7. Describe the type(s) of goods or services that you are or intend to use with the mark:

8. Are you already using the mark in connection with your goods or services?

Yes No 9. If yes, what is the first date you used the mark anywhere (including internal business use

such as on memos, prototypes, and graphics)? (mm/dd/yy) 10. If you already use the mark in connection with your goods and services, what is the first date

you used the mark in commerce, trade, or business with the public (including packaging,

advertisements, letterhead, and website)? (mm/dd/yy) 11. Have you applied for a foreign mark for your trademark?

Yes No If yes, please provide the serial or registration number and any documentation you have regarding the foreign mark.

12. Have you applied for a pervious U.S. registration for this trademark?

Yes No If yes, please provide the serial number and any documentation you have regarding the previous application.

Legal services for technology-based companies

_____________________________________________________________________________________ Ascentage Law, PLLC One Broadway, 14th Floor, Kendall Square, Cambridge, MA 02142 USA

TEL: +1.617.475.1603 www.ascentagelaw.com FAX: +1.617.401.3706

Page 3 of 3

Trademark Ownership

An individual, partnership, a sole proprietor, a trust, an estate, a corporate entity, or virtually any type of recognized entity may apply for a trademark as long as the entity exists prior to filing the trademark application.

Who will own this mark? (choose one, if more than one, please list all)

Individual/Sole Proprietor

Name:

Citizenship:

Residential Address:

City: State and Zip:

Country:

Business or Corporation

Company Name:

Business Address:

State and Zip:

State of Organization:

Type of entity (corporation/LLC/partnership/trust/other):