Form Pto/sb/124a - Request For Customer Number Data Change Page 2

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PTO/SB/124B (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.

Request for

Practitioner Registration Number

Customer Number

Supplemental Sheet

Data Change

Page

Pages

To the Commissioner for Patents:

Please record the following data

Changes to Customer Number:

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 indicated above:

Firm Name

Date

Additional supplemental sheet(s) attached hereto

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 2.