United  States   Patent  and  Trademark  Office
				Patent  &  Trademark  Copy  Order 

Complete all information requested below. For additional information, call (703) 305-8716.  
Return the completed form, using one of  the following addresses:

	Internet to:    ptcs@uspto.gov
	FAX to:         (703)  305-8759
	Mail to:        U.S. Patent & Trademark Office
			BOX 9  PTCS , Washington, D.C.  20231
___________________________________________________________________________________

			CUSTOMER    INFORMATION

Company or Name: ____________________________________  Phone : (      )_____________

Street: ______________________________________________  Phone Extension: _________

City: ________________________________ State/Province:___________________________

ZIP/Postal Code: _________________    Country: __________________________
						   
Contact Person, if different or not listed above:   ______________________Attn: _____________
___________________________________________________________________________________

		PREFERRED   DELIVERY   METHOD  (Select One Delivery Method ONLY)

____ Fax FAX #________________________
	 U.S.A. delivery rates:  $6.00/copy for overnight; $25.00/copy for 3-hour delivery;
	 Foreign fax is available.  Call or e-mail to the PTCS.
____ Fed Ex (cost varies by order size.  Delivered to address given above)
____ U.S. Mail ($3.00/copy.  Delivered to address given above)
____ PTO Box, List Box #:_________    Box delivery rates:  $6.00/copy for 24 hr 
	 delivery; all other $3.00/copy) 
___________________________________________________________________________________

			PAYMENT   INFORMATION   (Select  ONE  Payment  Method )

1.  Charge Card     Amount $____________    on ______VISA   or   ______Mastercard       

     Card #:  _________________________  Expr. Date: _______________ 
     Provide Card Holder's Name/Address if different from Customer Information above

     NAME_______________________________________

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2.  PTO Deposit  Account                      Deposit Acct #:  _________________________                            

     Amount Authorized:  $_________     Authorized Signature: ____________________

3.  Check or Money Order sent via mail in the amount of $  ___________
     Maill the Order Form and Check/Money Order together .  Allow 4 - 8 weeks for the mail.

___________________________________________________________________________________

				ORDER   INFORMATION

List the patent and/or trademark numbers, along with the appropriate prefix, next 
to the "ITEM" numbers listed in the space provided below.  
Be sure to indicate a prefix for copies of documents other than utility patents.  The
prefixes are:  
	Utility Patent - Use No Prefix;         Design Patent - DES;   
	Plant Patent - PP;                      Reissue Patent - RE;  
	Trademark - TM

#1  _____________________      #2  ______________________     #3  _____________________

#4  _____________________      #5  ______________________     #6  _____________________

#7  _____________________      #8  ______________________     #9  _____________________

#10 _____________________     #11 ______________________     #12  ____________________

___________________________________________________________________________________

			OPTIONAL  DELIVERY  LOCATIONS

To  Request  Delivery  to  Address(es)  Other  Than  the  one  given in the Customer  
Address Section  or  to multiple FAX  Numbers, complete the information below.  If you 
are requesting delivery to multiple locations, photocopy this sheet and submit one sheet 
for each location.

Company or Name: ____________________________________           
						
Street: ______________________________________________    

City: __________________________________        State/Province: _______________

ZIP/Postal Code: ____________         Country: _____________________________

				OR

Company or Name: __________________________________

FAX NUMBER: (      )_________________   Phone number (       )________________
					
Additional Comments: _______________________________________________________
__________________________________________________________________________
__________________________________________________________________________

	Internet to:    ptcs@uspto.gov
	FAX to:         (703)  305-8759
	Mail to:        U.S. Patent & Trademark Office
		        BOX 9  PTCS , Washington, D.C.  20231