[How To Request for Trademark Application] HARAKENZO WORLD PATENT & TRADEMARK - Leading Patent Law Firm in Japan(Osaka & Tokyo)

Trademark Application Request Form

Please fill the following request form (* is indicative of a necessary item) and push the send button so as to send the mail. Please describe this request form in English.

*Name
(corporate name or personal name of applicant)

Name of Representative
(in case of corporation)

*Address

*Phone number

*FAX number

E-Mail address

*Have you ever filed any trademark application?

Yes
No

*Trademark to be applied

*Goods or services on which the trademark is intended to be used

*Is priority under the Paris Convention claimed?

Yes

Country of Basic Application
Filing date
Application number

*Payment of fees for application

To be paid after negotiation
Paid into your bank account on (date of payment: Transfer form or the like is attached herewith)
If date of payment is "August 19 , 2006" , please input "20060819"

[ BANKER ]                                 SUMITOMO MITSUI BANKING CORPORATION
                                                      Tenroku Branch
                                                      6-4-19,Tenjinbashi,Kita-ku,OSAKA,JAPAN
                                                      Swift Code : SMBCJPJT130
                                                      Savings Account No. 6695895
                                                      Beneficiary : HARAKENZO WORLD PATENT & TRADEMARK
[ FAX number(Main Number) ]+81-6-6351-5664
[ e-mail ]