Wyoming Secretary of State State Capitol Building, Room 110 200 West 24th Street Cheyenne, WY 82002-0020 Ph. 307.777.7311 Fax 307.777.5339 Email: business@state.wy.us For Office Use Only Application for Registration of Trademark or Service Mark 1. Provide a written description of the trademark or service mark. Your description must include all words, names, symbols, devices and designs which the applicant wishes to be included within the mark. You may attach a separate sheet if needed; however, you must describe the trademark completely: 2. Name of applicant: 3. Business address of applicant: 4. Mailing address of applicant: 5. Applicant is (check one): individual; corporation; general partnership; limited partnership; limited liability company; statutory trust; unincorporated association; other: 6. a. If the applicant is a corporation, limited partnership, limited liability company or statutory trust, list: The state of incorporation or organization: The date incorporated or organized: (Date – mm/dd/yyyy) b. If a general partnership or limited partnership, list the names of the general partners or partners: c. If a limited liability company or statutory trust, list the names of the managers, members or trustees: d. If other, explain: 7. Provide the class number and title of the goods or services (see attachment). Use only one class code per registration: American LegalNet, Inc. www.FormsWorkFlow.com 8. Provide a brief description of the goods or services within the class (i.e., what your product is, or what service you provide): 9. List the mode or manner in which the mark is used to identify the goods or services (e.g.: goods - labels on cans, bags, wrappers, etc.; tags, nameplates affixed directly to product; services - labels on laundry bags, advertising, window signs, etc.): 10. An application to register the mark or portions or a composite has been filed by the applicant or a predecessor in interest in the U.S. Patent and Trademark office: Yes No If yes, provide filing date, serial number of each application, the status and, if any application was finally refused registration or has not otherwise resulted in registration, the reasons therefore: 11. Date of first use by applicant or predecessor (the mark must be in use before it can be registered): a. Anywhere: (Date – mm/dd/yyyy) b. In this state: (Date – mm/dd/yyyy) 12. One photocopy or facsimile of the mark as it is actually used must accompany this application. 13. The applicant is the owner of the mark. The mark is in use and to the knowledge of the person verifying this application, no other person has registered, either federally or in this state, or has the right to use such mark either in the identical form thereof or in such near resemblance as to be likely, when applied to the goods or services of such other person, to cause confusion or to cause mistake or to deceive. Date: Signature: ___________________________________________ (mm/dd/yyyy) Title: Contact Person: Daytime Phone Number: State of ____________________) County of __________________) Subscribed and sworn to before me this ____________ day of _____________________________, ____________. by______________________________________________________. (Notarial Seal) _________________________________________________________ Notary Public My commission expires: _______________________ American LegalNet, Inc. www.FormsWorkFlow.com Checklist Filing Fee: $100.00 Make check or money order payable to Wyoming Secretary of State. The Application must be accompanied by one photocopy or a facsimile of the trademark or service mark as it is actually used. The sworn application must be executed by the individual applicant or a member, manager, trustee, partner, officer or director of the applicant. Please submit one originally signed document and one exact photocopy of the filing. One copy will be returned to you showing the file date and file number. Please review form prior to submitting to the Secretary of State to ensure all areas have been completed to avoid a delay in the processing of your documents. Important Information: •Registration is effective for a term of five years and is renewable for like term upon application filed within six months prior to expiration of such term. •Renewal forms are mailed by the office of the Secretary of State to registrants whose trademark or service mark is up for renewal. •A trademark or service mark may be canceled at any time upon written request to the Secretary of State and payment of a $10.00 filing fee. •Assignment forms are available on the internet or from the office of the Secretary of State upon request. The filing fee to assign a trademark or service mark is $25.00. •Copies of the Wyoming Trademark statutes are available via the internet at http://legisweb.state.wy.us/statutes/statutes.aspx?file=titles/Title40/T40CH1.htm The following general classes of goods and services are established for convenience of administration of this Act,but not to limit or extend the applicant’s or registrant’s rights. A single application for registration of a mark may include any and all goods upon which, or service with which, the mark is actually being used in a single class. IF GOODS OR SERVICES FALL WITHIN TWO SEPARATE CLASS CODES, A SEPARATE REGISTRATION MUST BE SUBMITTED FOR EACH CLASS. Class Number and Title Goods 1. Raw or partly prepared materials 2. Receptacles 3. Baggage, animal equipment, portfolios, and pocketbooks 4. Abrasives and polishing materials 5. Adhesives 6. Chemicals and chemical compositions 7. Cordage 8. Smokers’ articles, not including tobacco products 9. Explosives, firearms, equipments, and projectiles 10. Fertilizers 11. Inks and inking materials 12. Construction materials 13. Hardware and plumbing and steam-fitting supplies 14. Metals and metal castings and forgings 15. Oils and greases 16. Paints and painters’ materials 17. Tobacco products 18. Medicines and pharmaceutical preparations 19. Vehicles 20. Linoleum and oiled cloth 21. Electrical apparatus, machines, and supplies 22. Games, toys, and sporting goods 23. Cutlery, machinery, and tools, and parts thereof 24. Laundry appliances and machines 25. Locks and safes 26. Measuring and scientific appliances 27. Horological instruments 28. Jewelry and precious-metal ware 29. Brooms, brushes and dusters 30. Crockery, earthenware, and porcelain 31. Filters and refrigerators 32. Furniture and upholstery 33. Glassware 34. Heating, lighting and ventilating apparatus 35. Belting, hose, machinery packing, non-metallic tires 36. Musical instruments and supplies 37. Paper and stationery 38. Prints and publications 39. Clothing 40. Fancy goods, furnishings and notions 41. Canes, parasols, and umbrellas 42. Knitted, netted and textile fabrics and substitutes therefor 43. Thread and yarn 44. Dental, medical, and surgical appliances 45. Soft drinks and carbonated waters 46. Foods and ingredients of foods 47. Wines 48. Malt beverages and liquors 49. Distilled alcoholic liquors 50. Merchandise not otherwise classified 51. Cosmetics and toilet preparations 52. Detergents and soaps Services 100. Miscellaneous 101. Advertising and business 102. Insurance and financial 103. Construction and repair 104. Communications 105. Transportation and storage 106. Material treatment 107. Education and entertainment TM-RegistrationApplication - Revised 12/2008 American LegalNet, Inc. www.FormsWorkFlow.com