USPTO Form 1611 Application for Recordal of Insignia or Renewal/Reactiva

Application for Recordal of Insignia
or
Renewal/Reactivation of Recordal
Under the Fastener Quality Act
15 U.S.C. Section 5401 et seq.
15 CFR Section 280.300 et seq.

USPTO Form 1611 (Rev. 09/2018)
U.S. Patent and Trademark Office
U.S. DEPARTMENT OF COMMERCE
OMB Control No. 0651-0028 (Exp. XX/XX/
XXXX)
Under the Paperwork Reduction Act of 1995,
no persons are required to respond to a collection
of information unless it displays
a valid OMB control number.

Application For Recordal Of Insignia or Renewal/Reactivation of Recordal Under the Fastner Quality
Act 15 U.S.C. Section 1504 et seq. (15 CFR Section 280.300 et seq.)

Instructions
To request recordal:
1. Complete sections 1 through 4 of USPTO Form 1611.
2. Sign and date the form.
3. Attach a copy of your trademark registration certificate or application drawing
page, as appropriate.
4. Attach a check or money order in U.S. currency or a completed credit card
authorization form, or include USPTO Deposit Account number for required fees.
5. Submit the form either by mail, by fax, or by e-mail.

To request renewal:
1. Complete sections 1, 2, 3 and 5 of USPTO Form 1611.
2. Sign and date the form.
3. Attach a copy of the certificate of recordal.
4. Attach a check or money order in U.S. currency or a completed credit card
authorization form, or include a USPTO Deposit Account number for required fees.
5. Submit the form either by mail, fax, or by e-mail.

To request reactivation:
1. Complete sections 1, 2, 3 and 6 of USPTO Form 1611.
2. Sign and date the form.
3. Attach a copy of the certificate of recordal.
4. Attach a check or money order in U.S. currency or a completed credit card
authorization form, or include a USPTO Deposit Account number for required fees.
5. Submit the form either by mail, fax, or by e-mail.
To submit the form via email

Please attach completed form, scanned
versions of required attachments, and
method of payment to an email, indicate
"ATTN: FQA" in the subject field, and
transmit to [email protected].

To submit the form via mail

Please send form, required attachments and
method of payment to the address below.

Director, USPTO
ATTN: FQA
600 Dulany Street
MDE 10-A71
Alexandria, VA 22314-5793

The credit card authorization form and instructions are available at
www.uspto.gov/web/forms/2038.pdf.
The fee for recordal, renewal and reactivation is currently $20 per application.
Fees are subject to change.If renewal is requested within six months following
the expiration of the certificate of recordal, a $20 surcharge is required.
For more information see www.uspto.gov/web/offices/ac/qs/ope/fees.htm
for current USPTO fee schedule.

Page 2 of 5

Application For Recordal Of Insignia or Renewal/Reactivation of Recordal Under the Fastner Quality
Act 15 U.S.C. Section 1504 et seq. (15 CFR Section 280.300 et seq.)

1

Applicant
If the applicant is an individual, please indicate the applicant's legal name.

(last name, first name, middle name/initial)

If the applicant is a corporation, the applicant's name is the name under which the applicant is
legally incorporated. If the applicant is a partnership, the applicant's name is the name under which
the applicant is legally organized.

2

Applicant’s Contact Information
Enter the applicant's entire business address, including ZIP or other postal codes. The applicant may
designate a correspondence address in the event correspondence should be sent elsewhere.
Note: The recordal applicant or the holder of a Certificate of Recordal must notify the USPTO in writing
of any change of address within six (6) months after the change.

Business Address
Street

Suite

City

State

Telephone

Email

Correspondence Address (if different)

Name

Street

3

Zip

Suite

City

State

Telephone

Email

Zip

Applicant’s Legal Entity & Citizenship
Individual Please enter the country of citizenship below.
Partnership Please enter the state where legally organized, or country, if appropriate,
AND the names and country of citizenship of all general partners below.

Corporation Please enter the state, or country, if appropriate, of incorporation below.
Other Please enter the specific nature of the entity and the state or country,
if appropriate, of citizenship below.

Page 3 of 5

Application For Recordal Of Insignia or Renewal/Reactivation of Recordal Under the Fastner Quality
Act 15 U.S.C. Section 1504 et seq. (15 CFR Section 280.300 et seq.)

4

Page 4 of 5

Request for Recordal
The applicant requests the USPTO to assign a unique alphanumeric designation
for recordal on the Fastner Insignia Register.
The applicant requests recordal of the mark on the Fastner Insignia Register
using the U.S. Registration Number or U.S. Serial Number entered below. The applicant
is the owner of the referenced trademark registration or application, which is not
cancelled, abandoned, or expired.

U.S. Application Serial Number
U.S. Registration Number
A copy of the registration certificate or
the drawing in the trademark application is attached.

5

Request for Renewal
A Certificate of Recordal remains "active" for a period of five years from the date of issuance. The USPTO
must receive a complete renewal application no later than six months after the expiration of that five-year
term or any five-year renewal term (the 10th year, 15th year, etc.), for your Certificate of Recordal to maintain
an active status.
The applicant requests renewal of the applicant's Certificate of Recordal based on either:

Trademark Application Serial Number
Trademark Registration Number
Alphanumeric Designation
A copy of the Certificate of Recordal is attached.
This collection of information is required under 15 U.S.C. § 5401 et seq. and 15 CFR 280.300 et seq. The
public submits the information in connection with requests to record, renew, or reactivate insignia under
the Fastner Quality Act of 1999; the USPTO uses the information to process these requests.
The time required to complete the form, including gathering information, preparing the form, and
submitting the completed requests to the USPTO is estimated to be 30 minutes. Time will vary depending
on the particular circumstances. Please direct comments on the time needed to complete this form, and/
or suggestions for reducing this burden to the Office of the Chief Administrative Officer, U.S. Patent and
Trademark Office, U.S. Department of Commerce, P.O. Box 1450, Alexandria, VA 22313-1450.
Do not send fees or completed forms to this address. Send them to:
Director, USPTO, ATTN:FQA, 600 Dulany Street, MDE-10A71, Alexandria, VA 22314-5793.

Applicant:

Application For Recordal Of Insignia or Renewal/Reactivation of Recordal Under the Fastner Quality
Act 15 U.S.C. Section 1504 et seq. (15 CFR Section 280.300 et seq.)

6

Page 5 of 5

Request for Reactivation
When a previously recorded alphanumeric designation is assigned to another entity the
recordal becomes "inactive" as of the date of the assignment. The new owner of the
alphanumeric designation must "reactivate" the designation by filling a new application
and requesting reactivation. The assignment documents must also be submitted with the
application. Note: Only one recorded alphanumeric designation may be reactivated per
application. Where a Certificate of Recordal is based on a trademark application or regis­
tration and the underlying application or registration has been assigned, the recordal shall
be designated "inactive" and CANNOT be reactivated. See 15 C.F.R. Section 280.323(b).
The new trademark owner must apply for a new recordal.
The applicant request reactivation of the recorded Alphanumeric Designation
listed below.

A copy of the assignment documents are attached.

7

Verification
The applicant identified below is a manufacturer as defined in 15 U.S.C. Section 5401. The applicant will
comply with the applicable provisions of the Fastener Quality Act (15 U.S.C. Sections 5401 et seq.). the
undersigned has knowledge of the facts relevant to the application and possesses the authority to act on the
behalf of the applicant. The undersigned declares, under penalty of perjury under the laws of the United
States of America, that the information and statements included in this application are true and correct.
The prescribed fee must accompany this application. You have three options to submit this form.
1. You may sign this form electronically by typing the applicant's name in between forward slashes
(example: /John Smith/ ) and click the submit button to e-mail your information to [email protected],
if you are paying the prescribed fee with a line for deposit account with the USPTO. Please e-mail us
any attachments.
2. You may print, manually sign, and fax this form to 571.273.8950 or print, manually sign, scan, and
e-mail all documents to [email protected], if you are paying the prescribed fee from a deposit account
with the USPTO. You may also fax or e-mail a completed credit card authorization form located at
www.uspto.gov/web/forms/2038.pdf.
3. You must print, manually sign, and mail this form if you are paying by check. Please mail the check with
this form. Keep a copy for your records.

Applicant's Signature
Print or Type Name & Position or Title of Signer
Date
Authorized User Signature

Applicant:

USPTO Deposit Account No.

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