Trademark Intake Questionnaire
Please complete all required fields so that we can best assist you. Should you have questions, feel free to email assistant@galvisandcompany.com.
What word, phrase, and/or image would you like to trademark?
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If your trademark consists of an image/logo, please attach it here.
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What is the name of the individual or company that will own the trademark?
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If a company/corporation: What type (LLC, S corp, etc.) and what is the state of incorporation?
If an individual, what is his/her/their country of citizenship?
What is the mailing address for the individual or company? Please note: This address will be publicly available on the U.S. Patent and Trademark Office's website once an application is filed. If an address should remain private, please be sure to notify us via email after completing the form.
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If you have a website, please provide the URL here.
What is the email address for the individual or company seeking to register the trademark?
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example@example.com
Please provide the best phone number for the individual or company seeking to register the trademark.
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Please enter a valid phone number.
Are you currently using the trademark?
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Yes
No
What goods or services are provided in connection with the trademark? What do you or your company sell, market, and/or distribute? What services do you provide? Please give as much detail as possible.
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When did use of the mark begin? This date can be approximate, such as November 2007. If you have not begun using your trademark, please enter N/A.
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If you have examples (pictures, screenshots of websites, brochures, etc.) of how you use your trademark, please upload them here.
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Some examples of ideal images for products include the label of a t-shirt with the trademark on it, a website offering a comforter for sale with the trademark on the checkout page, and packaging for a watch with the trademark on the package. Brochures and websites are only acceptable examples of use for services such as a bank offering checking accounts, advertising a dog walking business, or announcing the opening of a restaurant. If you are unsure, feel free to provide what you have. We will work with you to find the best examples of use for your products and/or services.
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