Finance, Office of - Deposit Account Application Form

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Office of Finance > Receipts Accounting Division > Deposit Account Branch > Deposit Account Application Form

PTO-2232 (02-2006)
Approved for use through 02/28/2009. OMB 0651-0043
U. S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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.

Please enter the information requested below, and then print the completed form on your local printer or use the print version to print. Please see the bottom of this form for mailing instructions.

If you require additional information about deposit accounts, the types of deposit accounts offered by the U.S. Patent and Trademark Office, and initial payment and fees required for establishing and maintaining a deposit account, please visit the Deposit Account Rules and Information page.

Date:
Type of Account Requested: Unrestricted (minimum $1,010) Restricted (minimum $310) Universal Public Work Station (UPWS) (minimum $310) (The required $10 account setup fee is included above.)
Company Name (to appear on monthly Deposit Account Statement):
Attention:
Address:
City, State, and Zip Code:
Telephone Number:
Fax Number:
Primary Contact Email Address:
Taxpayer ID Number:
If this account is for a government agency, please provide the Agency Location Code (ALC) #:

Authorized Users List:
Please attach additional pages as needed

Mailing Instructions: Please mail the completed form along with your initial deposit and the fee required to establish your deposit account (at least $1,010.00 or $310.00, depending on the type of account requested) to the address below. Please make checks payable to the Director of the United States Patent and Trademark Office.

Via first-class mail:
Mail Stop 16
Director of the US Patent and Trademark Office
PO Box 1450
Alexandria, VA 22313-1450

Via delivery service (e.g., FedEx, UPS, etc.):
Director of the US Patent and Trademark Office
Attn: Deposit Accounts
2051 Jamieson Avenue, Suite 300
Alexandria, VA 22314

If you have any questions or require additional information, please contact the Deposit Account Branch at (571) 272-6500

This collection of information is required by 35 U.S.C. § 41 or 15 U.S.C. § 1113 and 37 CFR 1.21(b), 1.25, 2.6, and 2.208. The information is required in order for the public to establish a deposit account at the USPTO. This form is estimated to take 2 minutes to complete, including gathering information, preparing, and submitting the completed Deposit Account Application Form to the USPTO. Time will vary depending upon the individual case. Please send any comments on the amount of time required to complete this form and/or suggestions for reducing this burden to the Chief Information Officer, USPTO, PO Box 1450, Alexandria, VA 22313-1450. DO NOT SEND FEES OR COMPLETED FORMS TO THIS ADDRESS. PLEASE REFER TO THE MAILING INSTRUCTIONS ABOVE FOR THE CORRECT MAILING ADDRESS FOR COMPLETED FORMS.

Privacy Act Statement for Deposit Account Application Form

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