Trademark Lodgement Authorisation

Application Type*

Name/WordsLogo/ImageCombined Name/Words & Logo/Image

Application Type*

Name/Words $450.00Logo/Image $450.00Combined Name/Words & Logo/Image $450.00

Name/Words

Logo/Image

Combined Name/Words & Logo/Image

Application owner details

Owner's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Postal address (If different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Classes*

List details of what you want to protect.

CONTACTING YOU

Name*

First NameLast Name

E-mail*

example@example.com

Phone Number

PAYMENT DETAILS

($450 AUD - Single Class)

Payment to Direct Bank or by Card*

Direct to Bank AccountCredit Card

Amount Due

DIRECT DEPOSIT TO BANK ACCOUNT:

Account Name: TradeMarks Australia™

Swift Code: BKWAAU6P

Bank: National Australia Bank

BSB: 084-961

Account No: 985196406

Please email a copy of the transfer to accounts@trademarksaustralia.com.au

Trademark Request

Name/Words

$450.00AUD

Logo/Image

$450.00AUD

Combined Name/Words & Logo/Image

$450.00AUD

Total

$0.00AUD

Credit Card

Please verify that you are human*

Trademark Application Form

Credit Card