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Preliminary Trademark & Servicemark Data Sheet
Type of Mark:
Name of Mark:
Applicant & entity name:
Entity’s incorporation information:
Business address of applicant:
Description of entity’s activity :
Telephone:
Fax:
Email Address:
Website URL:
Name and title of authorized signatory:
If Partnership, Name and addresses of partners
Is the Mark  
1. A proper name
2. A geographical location
3. A foreign word or symbol
Has the mark been used more than five years:
Date of first use:
Scope of Trademark. Describe goods/ services:
Age, father’s/ husband’s name and residential address of signatory :