Please mail registration and make check payable to: Secretary of State Ken Bennett / Trade Name Division

1700 W. Washington, 7th Fl., Phoenix, Arizona 85007 Walk-in service: Phoenix: 1700 W. Washington, 1st Fl., Room 103 Tucson: 400 W. Congress, Ste. 252 (602) 542-6187 (800) 458-5842 (within Arizona) Filing Fee: $15.00 Page 1 of 2

APPLICATION FOR REGISTRATION OF TRADEMARK/SERVICE MARK A.R.S. 44-1441 THROUGH 44-1455 The registration of Trademark/Service Mark is not legally required in Arizona, but is an accepted business practice. The registration of a trademark is a public record and does not constitute exclusive rights to the holder of the mark. Please clearly print or type to avoid errors in registration. Provide an accurate written description of your mark (logo or symbol):

Name of applicant(s):
(If more than 1 applicant, an or designation is assumed unless otherwise indicated)

Applicant must check one. Individual LLC Association Arizona Corporation Partnership Other Foreign Corporation licensed in Arizona. State of Incorporation: Mailing Address: Street or Box Number Phone (Optional): Description of goods on which this mark is used: Classification Number (Refer to the Trade Name & Trademark pamphlet.): Please attach three samples of your mark with this application on 8 1/2 by 11 inch paper that can be photocopied clearly. Examples include a letterhead, business card or advertisement, etc. Date Mark was first used: Date Mark was first used in this State: Please see page 2. City State Zip

Please mail registration to: Secretary of State Ken Bennett / Trade Name Division 1700 W. Washington 7th Fl. Phoenix, Arizona 85007 Walk-in service: Phoenix: 1700 W. Washington, 1st Floor, Room 103 Tucson Office: 400 W. Congress, Ste. 252 (602) 542-6187 (800) 458-5842 (within Arizona) Filing Fee: $15.00

Page 2 of 2 APPLICATION FOR REGISTRATION OF TRADEMARK/SERVICE MARK CONTINUED A.R.S. 44-1441 THROUGH 44-1455 Applicants Printed Name Applicants Printed Name State of Arizona County of ______________ On this ______ day of ______________________, 20___, before me personally appeared ____________________________, (name of signer(s)) whose identity was proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this document, and who acknowledge that he/she signed the above document. ________________________________ Notary Public Applicants Signature Applicants Signature

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