CHOOSING A BUSINESS NAME
 TRADEMARK, TRADE NAME, OR SERVICE MARK SEARCH
 QUESTIONNAIRE
 Once you have decided on a name for your business, products, or services, you may want
 to register that name.  Part of the registration process requires that a search be conducted
 to verify that no other business has already registered the name(s) you are considering.
 The following questionnaire identifies the information that will be required in order to
 conduct a proper search.
 APPLICATION FOR REGISTRATION OF:
 Trademark_____
 Trade name_____
 Service mark_____
 Applicant's
 name_______________________________________________________________
 On behalf of (business
 name)______________________________________________________
 I have authorization to act on behalf of the above-named business.
 Yes_____
 No_____
 Official
 title:___________________________________________________________________
 Applicant is a:
 Sole proprietorship_____
     Partnership_____
 Corporation_____
 Limited liability company_____
 Other_________________________
 If applicant is a sole proprietorship, are you a U.S. citizen? Yes_____
 No_____
 If applicant is a corporation, state of
 incorporation:_____________________________________
 Applicant's business
 address:_________________________________________________________________
 ________________________________________________________________________
 ________________________________________________________________________
 
 
 Applicant's  business telephone number, including area
 code:____________________________
 Applicant's business fax number:_______________________________________
 Applicant's business e-mail address:_____________________________________
 Application is for:  Federal registration only_____  State registration only_____
 Both_____
 State(s) in which registration is
 desired__________________________________________________________________
 ________________________________________________________________________
 Is registration outside of the United States desired? Yes_____
 No_____
 If so, in what other
 countries?_______________________________________________________________
 ________________________________________________________________________
 ________________________________________________________________________
 Date the name or mark began/will be in use:____________________________
 The name or mark will be used to identify (check all that apply):
 A business organization_____
 Goods_____ Services_____
 Registration is for (check all that apply):
 Word(s) only_____
 Word(s) in special lettering_____
 Logo or
 design_____
 Word(s) and logo_____ Company name_____
 Domain name_____
 Print, type, or attach the exact name or mark here.
 The name or mark relates to the following type of business, product(s), or service(s):
 ________________________________________________________________________
 ________________________________________________________________________
 ________________________________________________________________________
 ________________________________________________________________________
 
 
 Research conducted to date included the following resources:
 ________________________________________________________________________
 ________________________________________________________________________
 ________________________________________________________________________
 ________________________________________________________________________
 Results of that
 research:________________________________________________________________
 ________________________________________________________________________
 ________________________________________________________________________
 ________________________________________________________________________
 I have personal knowledge that all of the above information is true, complete, and
 accurate.
 _____________________________
 Date:__________________
 Signature of applicant
 On behalf of ___________________________