Trademark Clinic - Client Assignment

Intellectual property Law Clinic
Client Assignment Form
Request Date: 11/29/2015 3:00:06 PM
Client Name:
Case Number:
School USPTO #: TM-CWS
Client Address:
Street: (Include Suite #)
Other Details:
Contact name:
Contact Email:
Other Parties:
Description of Legal Request:
Time Sensitive:
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: