Trademark Assignment

Enter Assignor's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Assignee's Name *

Enter the receiving party's name

First Name

Last Name

Assignee's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nature of Assignment *

For "Nunc Pro Tunc" conveyances please provide the date of the conveyance in mm/dd/yyyy format in the following Nunc Pro Tunc date section. For corrective assignments please provide reel/frame of original original recordal in the Additional Information section below and/or attach a copy of the original coversheet for a corrective assignment. For 'Other" please indicate the nature of conveyance in the Additional Information section below.

Assignment of the entire interest and the goodwill

Assignment of an undivided part of assignor's interest

Nunc Pro Tunc Assignment

Merger

Merger and Change of Name

Change of Name

Entity Conversion

Corrective Assignment

Security Interest

Release of Security Interest

Lien

License

Letters Testamentary

Court Order

Other

Effective Date of Conveyance *

Enter the date of the conveyance in m/d/y format

MM

DD

YYYY

Date of Nunc Pro Tunc Conveyance *

Enter date of Nunc Pro Tunc conveyance in m/d/y format. Nunc Pro Tunc means "now for then," and refers to changing back to an earlier date and giving retroactive legal effect, as though the conveyance had been performed at a particular, earlier date.

MM

DD

YYYY

Credit Card Type *

Please select credit card type

Visa

American Express

Mastercard

Discover

Cardholder Name

First Name

Last Name

Credit Card Billing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Expiration Date *

Please enter credit card expiration date - **PLEASE ENTER "01" in the Day field

MM

DD

YYYY

Credit Card Authorization *

By checking this box you authorize Robert S. Broder, PLLC to charge your credit card the amount above.