Form Pto/sb/125a - Request For Customer Number

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PTO/SB/125A (11-08)

Approved for use through 01/18/2018. OMB 0651-0035

U.S. Patent and Trademark Office, U.S. DEPARTMENT OF COMMERCE

Under the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number.

Address to:

Request for

Mail Stop CN

Customer Number

Commissioner for Patents

P.O. Box 1450

Alexandria, VA 22313-1450

Although the Requester acknowledges that Internet communications are not secure, the Requester hereby authorizes

the USPTO to send the assigned customer number by e-mail to the email address listed below.

To the Commissioner for Patents:

Please assign a Customer Number to the address indicated below:

Firm or

Individual Name

Address

City

State

Zip

Country

Telephone

Please associate the following practitioner registration number(s) with the Customer Number assigned to the address cited above.

Additional practitioner registration numbers are listed on supplemental sheet(s) attached hereto.

Request Submitted by:

Firm Name (if applicable)

Signature

Name of person

Date

submitting request

Registration Number, if

Telephone Number

applicable

This collection of information is required by 37 CFR 1.33. The information is required to obtain or retain a benefit by the public which is to file (and by the USPTO to

process) an application. Confidentiality is governed by 35 U.S.C. 122 and 37 CFR 1.11 and 1.14. This collection is estimated to take 12 minutes to complete,

including gathering, preparing, and submitting the completed application form to the USPTO. Time will vary depending upon the individual case. Any comments on

the amount of time you require to complete this form and/or suggestions for reducing this burden should be sent to the Chief Information Officer, U.S. Patent and

Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS

SEND TO: Mail Stop CN, Commissioner for Patents, P.O. Box 1450, Alexandria, VA 22313-1450.

ADDRESS.

If you need assistance in completing the form, call 1-800-PTO-9199 (1-800-786-9199) and select option 2.