Doc Code: RFN.REQ
Document Description Refund
PTO-2326 (05-2021)
U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
REQUEST FOR REFUND
Reference #
(Patent #, Application #,
Trademark Serial #, Registration #, etc.)
Title of Invention or Mark Information
Attorney Docket # (if applicable) Payment Date (mm/dd/yyyy) Refund Request Amount
Refund Option
(Select one)
If approved, issue the refund to the account associated with the original payment.
If approved, and the original payment was a check, issue the refund to deposit account # __________________.
If approved, and the original payment was a check, issue the refund as a U.S. Treasury check.
Reason for Refund Request Refund requests must generally be filed within 2 years of payment date (37 CFR 1.26 and 2.209)
Duplicate Payment
Small Entity Later Established*
(*must be filed within 3 months of payment date, 37 CFR 1.28)
No Fee Due Office Error
Other ________________________________________________________________
Rationale (Supporting documentation may be submitted with this form)
Requester’s Information
Company or Firm Name (if applicable)
Address Line 1
City
State/Region
Address Line 2
(if applicable)
Country
Zip/Postal Code
You will receive an acknowledgment of receipt only if you provide a valid email address
Phone Number
Requester’s Name
Registration Number
(
if applicable
)
Signature
Date
(mm/dd/yyyy)
Submit online: EFS-Web (registered users only; select "Request for Refund" from the document description menu), or
Fax to: 571-273-6500, or
Mail to: Mail Stop 16, Director of the U.S. Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450