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SAMPLE FORM

TRADEMARK QUESTIONNAIRE

Purpose

The purpose of this Trademark Questionnaire is to (1) clarify the process of choosing of a trademark;

(2) create a legal document recording the dates of adoption and use; and (3) facilitate a higher quality and

less expensive trademark application.

Overview

Generally, the following major pieces of information will expedite trademark prosecution.

(1) Drawings, specimens or facsimiles of the trademark (preferably as actually affixed to the

goods or services on which the mark has been or will be used).

(2) A written description of all the goods or services on which the mark has been or will be

used.

(3) The dates of adoption, first use in commerce and first use in interstate commerce.

Specific Information

The following pieces of specific information are necessary for efficient trademark prosecution. Attach

additional pages as necessary.

1. Name, address and citizenship of applicant (owner of mark). Ray Martin¹

1520 E. Ave., Franklin, AZ 85301, United States¹

2. Entity type of applicant -- individual, partnership, corporation (including state of incorporation),

other. individual²

3. Describe in detail all goods and/or services on which the mark has been or will be used.

Books and computer software³

______________________________________________________________________________

Prior to Adoption of Mark

A trademark clearance search is highly recommended prior to adoption of the mark.

4. First choice for preferred mark. ⁴

Second choice for preferred mark. Ë

Third choice for preferred mark. ý

5. Is there a design, stylization, color or graphic aspect to mark? If so, describe.

Blue in color⁵

After Adoption of Mark

6. Date of first use in commerce. 8/21/95⁶

7. Date of first use in interstate commerce. 8/30/95⁷

8. Has mark been used continuously since the first use? Yes⁸

9. Attach three (3) specimens or facsimiles (i.e., labels, tags, engravings, stampings, etc.) of the mark

as it is actually applied to the goods or services.

10. Describe any similar marks used by others and the goods or services on which they are used.

None Known⁹

The above is an example of how a typical Trademark Questionnaire form may be completed.

1. The full name, address, and citizenship of the owner of the trademark.

2. The classification of the applicant.

3. A concise account of the products with which the trademark will be used.

4. Three alternate choices for the trademark.

5. Further description of the detail of the trademark.

6. The date on which the trademark will first be used on the market.

7. The date on which the trademark will first be used on the interstate market.

8. Indicate whether mark has been used continuously since its first date of use.

9. List and describe any other trademarks that are similar.

This is not a substitute for legal advice. An attorney must be consulted.