Trademark Renewals Secure Order Form

SECTION 1: REGISTRATION INFORMATION
Please provide us with the following information regarding the currently registered trademark for which your are requesting a Section 8 - Declaration of Use:
Name of the Trademark:
Registration Number
Registration Date
Date Format: MM slash DD slash YYYY
SECTION 2: OFFICER INFORMATION
Please indicate the name, title and phone number of the individual or Officer who is authorizing us to file this Trademark Renewal:
Signator
Position
Signator Phone
New Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

If different, please provide the trademark owner's new address (otherwise please leave it blank).
Website

If different, please indicate any additions or deletions to the current identification of goods and/or services (otherwise please leave it blank).
Goods & Services Description
Section 3: Contact Information
Please provide us with your name and contact info if different from the above.
Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Fax
Email*
Which number is greater?*
- One
- 11
Name
This field is for validation purposes and should be left unchanged.

Trademark Services Request Form