Instructions for Completion of
Application for Registration of a Trademark or Service Mark
See Form TM1
Applicant (owner name and address): The applicant is the individual or entity that owns the mark. The mark
will be used to distinguish the goods or services of the owner from those provided by others. The name of the
applicant (owner) may be determined by the entity type in Item 3. If the applicant is a partnership, both
individuals must be listed as the owner and both must sign the application before a notary public.
Contact person name and address: Name and address of person we may contact with any questions we may
have. Please furnish an email address, if available.
Applicant is a: Select one of the entity types below that best identifies the type of entity of the applicant. Also
indicate the applicant’s state or jurisdiction of formation:
Limited Liability Partnership
Non Public Corporation
Corporation of the Commonwealth
Limited Liability Company
Real Estate Investment Trust
Federally Chartererd Savings Bank
Local Government Authority
National Banking Association
Kind of mark: Indicate whether you are requesting registration of the mark as a trademark or service mark. A
trademark is any word, name, symbol, device or combination thereof, used by a manufacturer or merchant to
identify its goods and distinguish them from others. (Example: brand names identifying goods such as Pepsi
Cola for a soft drink). A service mark is any word, name, symbol, device of combination thereof, used by a
manufacturer or merchant to identify its services and distinguish them from others. (Example: identifies services
such as McDonald’s for a restaurant service).
Identify trademark or service mark (or attach an exhibit): Indicate what the mark is on this line. If the mark is
comprised of words only, type or write the words here. If the mark also includes a design, symbol or image,
attach an exhibit of the mark to the application. An exhibit is a blank piece of paper with an appearance of the
mark only without extraneous markings.
Class number(s) of goods or services: Indicate in which class you wish to register the mark. Classes are
groupings or categories of goods and services (see 21 VAC 5-120-100). Trademark classes are 1 through 34;
service mark classes are 35 through 42. The registration fee is $30 per class. (Example: The fee for registering
one mark in two classes would be $60). Please use separate applications if requesting registration as both a
trademark and service mark.
Describe the product or service(s) the mark represents (identifies): Describe the product (trademark) or
service(s) provided (service mark) which the mark identifies. (Trademark example: manufacture and
production of labeled brunswick stew for public consumption. Service mark example: Service which includes
maintenance and repair of automobiles).
Date mark was first used: Provide the dates the mark was first used anywhere and first used in Virginia. The
mark must be in use, in commerce, in the Commonwealth of Virginia prior to submitting the application.
Item 10 Please Note: A specimen of the mark must accompany this application: Provide a specimen of the mark
which demonstrates the manner in which the mark is being used. (Example: An appropriate trademark
specimen may include an actual label affixed to the product, or a photograph of the product with the mark
clearly visible. Service mark specimens may include actual letterhead, stationary, business card, advertisement
dated within the past year and the name and date of the publication in which it was published).
Signature of applicant & notary public – The application must be signed before a notary public.
Additional assistance can be obtained by calling (804) 371-9051 or at
Mailing address: Division of Securities & Retail Franchising, PO Box 1197, Richmond, VA 23218