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`Document Description: Refund Request
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`PTO-2326 (05-2022)
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`U.S. Patent and Trademark Office; U.S. DEPARTMENT OF COMMERCE
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` Reference # (Patent #, Application #,
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`Trademark Serial #, Registration #, etc.)
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`REQUEST FOR REFUND
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` Title of Invention or Mark Information
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` Attorney Docket # (if applicable)
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` Payment Date (mm/dd/yyyy)
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`Refund Request Amount
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`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 # __________________.
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`If approved, and the original payment was a check, issue the refund as a U.S. Treasury check.
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` Reason for Refund Request Refund requests must generally be filed within 2 years of payment date (37 CFR 1.26 and 2.209)
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`Duplicate Payment
`No Fee Due
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`Office Error
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` Small Entity Later Established*
`(*must be filed within 3 months of payment date, 37 CFR 1.28)
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`Other ________________________________________________________________
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` Rationale (Supporting documentation may be submitted with this form)
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`Requester’s Information
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` Company or Firm Name (if applicable)
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`Address Line 1
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` Address Line 2 (if applicable)
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`City
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`Country
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`State/Region
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`Zip/Postal Code
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` Email Address
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` (You will receive an acknowledgment of receipt only if you provide a valid email address)
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`Phone Number
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` Registration Number
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`(if applicable)
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` Date (mm/dd/yyyy)
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`Requester’s Name
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`Signature
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`Submit online: USPTO's patent electronic filing system (Patent Center or EFS-Web), or
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`Fax to: 571-273-6500, or
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`Mail to: Mail Stop 16, Director of the U.S. Patent and Trademark Office, P.O. Box 1450, Alexandria, VA 22313-1450
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