Trademark Renewals Secure Order Form | 4 Trademark

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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 Mark:*
Registration Name*
Registration Date*
SECTION 2: OFFICER INFORMATION
Please indicate the name, title and phone number of the individual who will sign this Declaration on behalf of the current trademark owner:
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 indicate the individual representing the trademark owner to be contacted regarding this matter.
Name*
First Last
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Fax
Email*
Email
This field is for validation purposes and should be left unchanged.

Name
First Last
Email
Phone
This field is for validation purposes and should be left unchanged.