Form Pto/sb/124a - Request For Customer Number Data Change

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Doc Code:

PTO/SB/124A (12-08)

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 EBC

Customer Number

Commissioner for Patents

Data Change

P.O. Box 1450

Alexandria, VA 22313-1450

To the Commissioner for Patents:

Please record the following data changes to Customer Number:

Please change Address to:

Firm or

Individual

Name

Address

City

State

Zip

Country

Telephone

Please delete the following practitioner registration number(s) from the Customer Number indicated above:

Please add the following practitioner registration number(s) to the Customer Number above:

Additional practitioner registration numbers are listed on supplemental sheet(s) attached hereto (PTO/SB/124B or equivalent)

Request Submitted by: (

must be a person, e.g. registered practitioner, associated with the customer number shown above)

Firm Name (if applicable)

Signature

Name of Person

Registration

No.

Submitting request

Telephone Number

Date

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 EBC, 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.