Application For Registration Or Renewal Of Trademark Or Service
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1
2
3For Office Use Only
T -
Registration Number
APPLICATION FOR REGISTRATION OR RENEWAL
OF TRADEMARK OR SERVICE MARK
STATE OF NORTH CAROLINA
Pursuant to N.C.G.S. §80-3 and §80-5 the undersigned hereby makes application for the registration or renewal of a Trademark or
Service Mark and submits the following information:
1. The application is for:
____ Initial Registration - $75.00 (Fees are non-refundable)
____ Renewal - $35.00 (Fees are non-refundable) Registration No. T - ____________
OWNER/APPLICANT INFORMATION
2. Name of Owner/Applicant of the Mark (Individual or Business Entity):________________________________________
_______________________________________________________________________________________________
3. The undersigned Owner/Applicant is: (Must check one box only and the selection must match the information in #2)
an individual
a sole proprietorship
an association
a government
a union
a corporation or limited liability company (LLC), indicate the state of incorporation or
organization: _______________________________________________________
a partnership, indicate the state of organization: __________________________________________________
List the names of the general partners: _________________________________________________________
(Attach a continuation sheet, if necessary)
4. Owner/Applicant Business Address: __________________________________________________________________________
Contact Name: ________________________________________________________________ Attorney : Yes _____, No _____
Contact Mailing Address:___________________________________________________________________________________
Telephone:__________________________Contact E-mail: _______________________________________________________
[You can register only one type of mark per application, a Trademark OR a Service Mark]
5. For Trademarks (Only if producing a product or good)
6. For Service Marks (Only if providing a service)
The principal place of business or distribution in
The physical location where services are being
this State.
rendered or offered in this State.
______________________________________________
_________________________________________________
Address
Address
______________________________________________
________________________________________________
City
State
Zip
City
State
Zip
Check as many as apply
Check as many as apply
The Trademark is applied:
The Service Mark is applied:
_____ Directly to the goods;
In advertisements of the service;
_____ Directly to containers for the goods;
_______ On documents, wrappers or articles
_____ To tags/labels affixed to the goods; or
delivered in connection with the services
_____ By displaying it in physical association with
rendered; or
the goods in sale or distribution thereof
In the following specified manner:
________________________________
________________________________
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