North Carolina Department Secretary of State TRADEMARK SECTION Request for Trademark/Service Mark Copies Personal Name: Phone: (___)____________ Business Name: Mailing Address: Email Address: Fax#: (___)________________ A. Tell us about Trademark/Service Mark; fill in below what you know: Registration Number __________ or Describe the words or what the mark is (design/slogan) _________________________________ ______________________________________________________________________________ Who is the Owner/Applicant of the mark? _____________________________________________ B. Check all that apply: (You may call the Trademark Section at (919) 807-2162 to determine the cost of this request) _____ Certified Copy _____ Quantity ($5.00 for first page and $1.00 per page thereafter) _____ Application for Registration _____ Registration Certificate ______ Specimens Submitted _____ Other (please specify) __________________________ Entire File ____________ _____ Copies Only _____ Quantity ($1.00 per page) _____ Application for Registration _____ Registration Certificate ______ Specimens Submitted _____ Other (please specify) __________________________ Entire File ____________ C. Your total cost here: ____________________ (attach check or money order made out to the North Carolina Department Secretary of State) D. Check one: _____ Mail _____ Pick-up (please allow at least one business day for pickup) Special Notes: January 2000 >>>> 2 NO COPIES WILL BE MADE WITHOUT PREPAYMENT January 2000