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Use this form to request a MarkAssure Report, including use of a coupon. Do not use this form to pay an outstanding invoice.

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Enter the mark or marks that you want monitored, such as ACME, and include any federal trademark office or international application or registration number, separated by commas. Do not include more than one mark for a coupon.
Name
Name
First
Last
Only a valid coupon will be accepted. If you are entering a coupon, if more than one mark is specified, only the first will be used. Any coupon has no independent value and is for marketing purposes only to new customers. It may not be applied to any current mark or by any current customer. See https://markassure.com/coupons. MarkAssure® may refuse applying the coupon in its discretion.
We need a physical office address related to this purchase if you are not a current customer.
Use Card on File
Field not required. If this credit card is, e.g., from other than the client name or at an address not associated with the person or client, this field allows you to indicate special data that may be required for the card not otherwise part of the account. Enter any special instructions.
Authorize
By clicking the I Agree button, you are agreeing to the terms and conditions as stated above. You will be contacted by the firm only if your order is accepted. This is an authorization form, your card will be contacted following submission. You should print this page for your records.