This agreement entered ______________ (day) of ______________(month), ________ (year) between _______________________ (name of assignor) , of _____________________ (address),__________________ City of _______________ (state) , herein referred to as “Assignor”, and ________________ (name of assignee) of ____________________ (address), City of _______________ (city),__________________ State of , herein referred to as “Assignee”.

That Assignor has adopted and is using a mark registered in the _________________________ (place) Patent Office, Registration No. ______________ (number),_______________ (date)dated and Assignee is desirous of acquiring such mark and the registration thereof.

That for good and valuable consideration, the receipt of which is hereby acknowledged, Assignor does hereby assign to Assignee all rights, title and interest in and to said mark, the goodwill of the business symbolized by said mark, along with the registration thereof, the number of which is contained herein.

Date____________________
________________________
[Signature]
[Acknowledgment]