This agreement entered this [day] of [month]， [year] between  [name of assignor] ， of [address]， City of [city] State of   [state] ， herein referred to as "Assignor"， and [name of assignee] of [address]， City of  [city]， State of [state]   ， herein referred to as "Assignee".

　　That Assignor has adopted and is using a mark registered in the United States Patent Office， Registration² No. [number]， dated  [date]  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 goodwill³ of the business symbolized⁴ by said mark，along with the registration thereof， the number of which is contained herein.

　　Date____________________

　　________________________

　　[Signature]

　　[Acknowledgment]