Incorporate in Delaware. Delaware corporation or limited liability company, llc filed In 24 Hours.

PLEASE PRINT, COMPLETE AND FAX THIS FORM TO (703) 995-0899)
Part I - CREDIT CARD AUTHORIZATION FORM - TradeMark Billing Information

__________________________________ DOES HEREBY AUTHORIZE THOMPSON & THOMPSON PC
(Name on Card)
to charge the amount of $ 2495.00 for Name or Logo ** Please see below

to its:

Account No. __________________________________ Expiration Date _____________ CVV Security Code

Credit Card Billing Address _________________________________________________
(if mail forwarding address is different, use separate sheet of paper)

City, State, Zip _____________________________________________________________

Telephone No. ________________________ Fax No. _____________________________

Email Address ___________________________________________

Signed By ____________________________________ Social Security # _______________________

Title __________________________ Dated ______________________

We also accept payment by PayPal. To pay by PayPal our email address is globpj@concentric.net

Part II - Information Required to complete the Application for the TradeMark

(Please do not leave any information blank).

Your Name ______________________________ Office/Position/Title ______________________

Company Name __________________________________________________

Company Address ________________________________________________

City, State, Zip ___________________________________________________

Telephone _______________________ Fax ___________________________

Email Address ____________________________________________________

Before submitting an application for trademark registration, you may need to provide us with specimens evidencing your use of the mark, a drawing, and additional information. We will contact you regarding any additional information upon receiving this request form. Please complete the following:

1. Briefly describe the types of goods and/or services identified by the trademark: (be specific - this helps us identify the proper registration classes)

_______________________________________________________________________

2. Describe how the trademark is or will be used with the goods and/or services (such as being applied to labels, product packages, advertisements, etc.):

_______________________________________________________________________

Is your organization already incorporated? Yes No -

State of Incorporation ______________________ Year Incorporated ______________

Employer ID Number (EIN) __________________________________

Is your request urgent? Yes No If yes, please describe the urgency.____________________________________

_____________________________________________________________________________

______________________________________________________________________________

Thank you for your prompt attention to this invoice. Global Corporate Services, Inc. does not provide personal counsel or tax advice. The application and credit card will be processed by our attorneys, the firm of THOMPSON & THOMPSON PC.

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