European Trade Mark Portal

Please fill in the boxes carefully.

I am a local representative
I am a company
I am an individual

Office (Name):
Address:
Post code/City (US: zipcode):	/
Country:	«
Fax:
Email:
Reference:
Contact person:

Local representative declares that he is
authorized to give sub-authorization in this matter:

Applicant

Name:
Address:
Post code/City (US: zipcode):	/
Country:	«
Governing state:
State of nationality:

Designer/Author

Name:
Address:
Post code/City (US: zipcode):	/
Country:	«
State of nationality:

Please address the debit note to the following address instead of the local representative:

Name of the addressee of the debit note:
Address:
Post code/City (US: zipcode):	/
Country:	«

Applicant

Name:
Address:
Post code/City (US: zipcode):	/
Country:	«
Governing state:
Fax:
Email:
Reference:
Contact person:

Designer/Author

Name:
Address:
Post code/City (US: zipcode):	/
Country:	«
State of nationality:

Applicant

Name:
Address:
Post code/City (US: zipcode):	/
Country:	«
State of nationality:
Fax:
Email:
Reference:

Designer/Author

Name:
Address:
Post code/City (US: zipcode):	/
Country:	«
State of nationality: