Application For Registration Of A Trademark Or Service Mark Form - South Carolina Secretary Of State Page 6

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State of South Carolina
Application for Registration of a Trademark or Service Mark
Part 1: Type of Application
[ ] New mark: $15.00 per class
Check one: [ ] Trademark OR [ ] Service Mark
[ ] Renewal of existing mark: $5.00 flat fee for application
(
Trademarks/Service Marks cannot be combined on same form)
Part 2: Applicant Information and Mark
1. Name of Applicant:
2. Applicant’s principal place of business address:
3. Applicant’s place of business address in South Carolina, if any:
4. Applicant is: [ ] an individual or sole proprietor
[ ] a corporation duly organized under the laws of the State of
[ ] a limited liability company duly organized under the laws of the State of
[ ] a partnership duly organized under the laws of the State of
Names of General Partners:
[ ] other
Please note that the entity type must match the applicant noted in question (1). For example, applicant John Smith would be an
individual or sole proprietor, while ABC Company, Inc. would be a corporation.
5. Describe the look of the mark, including any wording and/or graphics:
The mark described must be present on the three (3) identical specimens submitted with the application.
6. The actual goods or services in connection with which the mark is used
(for example, a social club, heating repair services,
:
perfume, BBQ sauce)
7. The mode or manner in which the mark is used
(please see paragraphs (7) and (11) of the instructions for additional
:
information)
8. The class(es) in which the goods or services fall:
Please make your selection of classes from the “Classes of Goods and Services” provided in the instructions. Trademark classes are
listed under Section 39-15-1150(B), while service mark classes are listed under Section 39-15-1150(C).
9. The mark, with respect to the goods or services identified above, was first used by applicant or predecessor in interest
as follows (include month, day, and year):
Date of first use anywhere: _____/_____/______
Date of first use in South Carolina: _____/_____/______
month day year
month day year
10. Has the applicant, or any predecessor in interest, ever filed an application to register this mark or portions of this
mark or a composite of this mark with the United States Patent and Trademark Office? [ ] YES [ ] NO
If you answered "YES", please list the filing date, serial number and status of each application. If an application was
finally refused registration or has otherwise not resulted in registration, please state the reason for this:

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