Trademark Disclosure Forms

1
Name of The Mark* This field is required.
2
Description of The Mark* This field is required.
Huge
Large
Normal
Small
Ok
Ok
3
What does your business sell?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
4
What goods and/or services do you offer under the mark?* This field is required.Please list in detail every item or service that you plan on selling under this trademark. Please be as specific as possible when listing examples. For example hoodies, t-shirts, hats, instead of "clothing".
Huge
Large
Normal
Small
Ok
Ok
5
Is the mark printed on the goods?
YESNO
6
Have you ever used this mark?
YESNO
7
Please provide website URLs or any other examples showing the goods or services being offered under the mark.
Huge
Large
Normal
Small
Ok
Ok
8
Our flat fee includes one class of goods/services. Each additional class is $550. Please visit the USPTO Trademark ID Manual at https://idm-tmng.uspto.gov/id-master-list-public.html to identify the specific class(es) you would like to file under, and provide the class number(s) along with a description of the goods or services you offer in the field below. Of course, we are happy to assist with this, and providing this information is not a firm requirement, but doing so will improve efficiency and timing in delivering your draft.
Huge
Large
Normal
Small
Ok
Ok
9
What is the date this mark was first used anywhere?* This field is required.
Date
Year
Month
Day
10
If the mark is already being used in commerce, please provide the date it was first used. If you have not used the mark in commerce yet you can leave this blank.
Date
Year
Month
Day
11
Do you know of anyone else using this or a similar mark? If so please provide details. * This field is required.If not, please state that you are unaware of anyone else using this mark or a similar mark.
Huge
Large
Normal
Small
Ok
Ok
12
Name - Owner of Mark* This field is required.This can be an individual or business.
13
Owner Name (For OneDrive)
14
Owner of Mark Details* This field is required.Leave blank if this is not applicable
Address - Owner of Mark
Phone - Owner of Mark
Email - Owner of Mark
15
Country of CitizenshipIf mark is owned by an individual.
16
Type of CorporationIf the owner of your mark is an individual you can leave this blank.
17
State/Country Where Legally OrganizedIf the owner of your mark is an individual you can leave this blank.
18
Name for USPTO Correspondence * This field is required.This person will be listed as a primary contact regarding your Trademark application with the USPTO.
First Name
Last Name
19
Address for USPTO Correspondence * This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
20
Phone for USPTO Correspondence * This field is required.
Area Code
Mobile Phone Number
21
Fax for USPTO Correspondence If you do not have a fax you can leave this blank.
Area Code
Fax Number
22
Person Submitting The Form* This field is required.If this is the same as the owner information you can skip this question.
First Name
Last Name
Email
Business Phone
Cell Phone
Mailing Address
23
Please upload any proof of use of the mark in the public domain.dThis can include websites with the mark, advertisements showing the mark, packaging with the mark, clothing with the mark, etc.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
24
By signing below, I hereby affirm that the information I have provided herein is true and accurate, and I hereby authorize The Rapacke Law Group, P.A., as my agent and attorney, to file under my name and sign my name to a USPTO Trademark Application based on the same.* This field is required.Please draw your signature below.
Should be Empty: