Trademark Clinic - Client Assignment

Intellectual property Law Clinic
Client Assignment Form
 
Request Date: 4/16/2014 6:11:57 AM
 
Client Name:
Case Number:
School USPTO #: TM-CWS
Phone:
 
Client Address:
Street: (Include Suite #)
City:
State:
Zip:
 
Other Details:
Contact name:
Contact Email:
Other Parties:
 
Description of Legal Request:
 
Time Sensitive:
Explain:
 
Supporting documentation:
 
Income Verification:  
Qualifying persons need to have been in business for five years or less with net gross revenue under $250,000. We hae a privacy policy and will not disclose any financial information you provide.
Proof provided:
 
I hereby give my consent to release the above information for purposes of verifying my income to entitle me to free legal service, which is a condition of my participation in the clinic.
 
Full printed name: