This form should be filled out if you are considering applying for a trademark with the USPTO and returned to info@ascentagelaw.com.

1. Legal services for technology-based companies
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).
_____________________________________________________________________________________
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
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2. Legal services for technology-based companies
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.
_____________________________________________________________________________________
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
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3. Legal services for technology-based companies
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):
_____________________________________________________________________________________
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
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