Bernstein & Associates

Attorneys At Law, P.C.

6600 Peachtree Dunwoody Road, N.E.
Embassy Row 400, Suite 495
Atlanta, Georgia 30328-1649

(770) 671-1755

(770) 671-1161 fax

Intelligent Innovation Management^sm

TRADEMARK SEARCH/APPLICATION QUESTIONNAIRE

What is the TRADEMARK to be Registered?: _______________________________________________________

TYPE OF MARK TO BE REGISTERED (CIRCLE): WORDS DESIGN BOTH

who will own the mark? ___________________________________________________________________________

is the owner a (circle one): (individual / corporation / partnership / llc / LLP / other)

State/Country of Organization/Citizenship of owner :___________________________________________

Address 1: ____________________________________________________________________________________________

ADDRESS 2: ___________________________________________________________________________________________
CITY STATE ZIP COUNTRY

Website: ___________________________________________________________________________________________

E-Mail: ____________________________________________________________________________________________

PHONE: ___________________________________ FAX: ___________________________________

what PRODUCTS and/or SERVICES ARE BEING sold or will be sold under this?:

________________________________________________________________________________________________________

________________________________________________________________________________________________________

what areas of expansion MIGHT YOU USE THE MARK IN THE FUTURE that are not listed above?

________________________________________________________________________________________________________

HOW IS THE MARK USED NOW or intended to be used? (check all of the appropriate boxes)

GOODS/PRODUCTS SERVICES

__ PRINTED ON PACKAGING __ BROCHURES __ trade publications

__ LABELS __ ADVERTISEMENTS __ newspapers

__ PRINTED ON THE PRODUCTS __ fliers __ catalogues

__ instructions/packaging inserts __ yellow pages

__ computer software manuals

__ printed on the products __ promotional materials such as:
__ on photographs of the product

__ other: ________________________________ __ Other: ___________________________________________

sales

have you sold any of the goods or PROVIDED services yet under the mark? Y ___ n___

IF YES, ON WHAT DATE DID YOU MAKE YOUR FIRST SALE? (MONTH/DAY/YEAR): __________________________

HAVE YOU MADE ANY SALES OUTSIDE OF YOUR HOME STATE OR TO A CUSTOMER IN A FOREIGN COUNTRY? Y ___ n___

iF SO, ON WHAT DATE DID YOU first SELL OUT OF STATE OR IN Another COUNTRY? ? (MONTH/DAY/YEAR):_____________

The following questions should be completed if your goods/services are software and/or database related:

if you are providing access to a software product, WILL THE LICENSED software reside on your customer’s hard drive or on your web server?

customer_______________ mine_____________

if on the customer’s drive, how is the customer’s copy delivered?

via CD ROM/disk__________ downloaded off the internet___________

if your products or services involve databases, whose databases are used?

mine____________ customer’s_____________ third parties’___________

IF THE APPLICATION IS AN ACTUAL USE BASED APPLICATION WE WILL NEED two SPECIMENS OF THE MARK AS USED IF THE MARK IS A DESIGN WE WILL NEED A BLACK/WHITE DRAWING OF THE DESIGN/LOGO

PLEASE FAX BOTH PAGES OF the SIGNED QUESTIONNAIRE BACK TO Brandi Watson either by fax 770-671-1161. Or, mail to: Bernstein & Associates, P.C., 6600 Peachtree Dunwoody Road, N.E., Embassy Row 400, Suite 495, Atlanta, GA 30328-1649.

We will prepare the application from this information for your review and signature and file it on your behalf.

Thank you for taking the time to complete this document.