INSTRUCTIONS FOR COMPLETION OF APPLICATION FOR REGISTRATION OF A TRADEMARK OR SERVICE MARK(See Form TM1, next page)Applicant (owner name and address): The applicant is the legal name of the entity (see Item 3 below) that owns the mark. .If the applicant is a partnership, each individual must be listedas the owner and each individual must signthe application before a notary public Contact person name and address:Nameand address of person we may contact with any questions we may have. . Applicant is a: Select one of the entity types below that best identifies the type of entity of the applicant. Also indicate the applicant222s state or jurisdiction of formation Kind of mark: Indicate whether you are requesting registration of the mark as a trademarkor service mark.Use separate applications if requesting registration fora trademark and service mark.trademark(Example: brand names identifying goods such as Pepsi Cola for a soft drink). service mark(Example: identifies services such as McDonald222s for a restaurant service). Identify trademark or service mark (or attach an exhibit): Indicate the mark to be registered on this line. Type or write the words if the mark is comprised of words only. An exhibit is a separate sheet of paper depicting the appearance of the mark only without extraneous markings Registration fee and class number(s) of goods or services: Indicate in which class you wish to register the mark. (see 21 VAC 5-120-100). Trademark classes;service mark classes.The non-refundable registration fee is $30 per classmade payable to Treasurer of Virginia. (Example: The fee for registering amark in two classes would be $60). Describe the product(s)or service(s) the mark represents (identifies):trademark service mark(Trademark example: manufacture and production of labeled brunswick stew for public consumption. Service mark example: Service which includes maintenance and repair of automobiles). Date mark was first used:Provide the dates the mark was first used anywhere and first used in Virginia. , A specimen of the mark must accompany this application A trademark specimenmay be an actual label and a photograph of the label affixed to the product, brochure, etc. A service mark specimenmay be an original business card, letterhead, brochure, advertisement dated within the past year and the name and date of the publication in which it was published, a printed webpage on which the URL address and date are displayed. Signature of applicant & notary public Additional assistance can be obtained by calling (804) 371-9051 or at www.scc.virginia.gov/srf. Mailing address: Division of Securities & Retail Franchising, PO Box 1197, Richmond, VA 23218 American LegalNet, Inc. www.FormsWorkFlow.com American LegalNet, Inc. www.FormsWorkFlow.com