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Inventions Disclosure Form for Newly Filed Patent Applications
Inventors Notes. The purpose of this form is to help collect the information necessary for our firm to evaluate your invention in order to determine whether patent protection can be and should be sought. This form is an important legal document and care should be taken in preparing it. Please provide sufficient amounts of information that will assist in understanding the technical merits of the work, the commercial usefulness, and practical applications so Mrs. Miller can be more effective in advising you. If you have any questions while you are completing the form, please call our office and we will be available to assist you.
Step 1 of 8 - Applicant Information
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Select the patent service for the Initial Consultation.
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New Patent Application
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Person Submitting Disclosure
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Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
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Last
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Applicant Phone
*
This is the phone number our client coordinator may use to contact you.
Applicant Email
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This is the email our client coordinator may use to contact you.
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Applicant Type
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Inventor
Joint Inventors
Assignee
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Which of the following best indicates who will be taking control of the patent application? If you are the only inventor and have not sold the patent rights, then select "Inventor". If there is more than one inventor then select "Joint Inventors". If you have sold the patent rights, then select "Assignee".
Assignee Information
Assignee Name (Company Name)
Full Name
*
What is the name of the individual acting on behalf of the company listed above?
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
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Title
President
Vice President
Secretary
Member
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Assignee Phone
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Assignee Email
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Website
Residential Address
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Same as previous
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
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District of Columbia
Florida
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Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
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Louisiana
Maine
Maryland
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Michigan
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New Hampshire
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New Mexico
New York
North Carolina
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Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mailing Address
*
Same as previous
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Inventor Information
First Named Inventor
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Middle
Last
Suffix
Are you 65 or older?
*
Yes
No
Inventor No. 1 Phone
*
Inventor No. 1 Email
*
Enter Email
Confirm Email
Website
Residential Address of Inventor No. 1
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mailing Address of Inventor No. 1
*
Same as previous
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Citizenship
*
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
United States
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Reduced Fee Status
We are dedicated to helping independent inventors and small businesses assert Small Entity Status or Micro Entity Status, allowing them to pay a fraction of the regular amount for most governmental fees.
Are you either an independent inventor or a non-profit organization?
*
Are you either an independent inventor or a non-profit organization?
Yes
No
Unsure
Do you have more than 500 employees?
*
Yes
No
Unsure
Have you assigned, granted, conveyed, or licensed any rights in the invention to any person who made it and could not be classified as an independent inventor, or to any concern which would not qualify as a non-profit organization or a small business concern?
*
Yes
No
Unsure
Are you named on more than four previously filed applications? Do not count Provisional Patent Applications.
*
Are you named on more than four previously filed applications? Do not count Provisional Patent Applications.
Yes
No
Unsure
Does the inventor have a max. gross income of more than $189,537 for the preceding calendar year the application fee will be paid?
*
The "Maximum Qualifying Gross Income" for purposes of paying any eligible fee at the micro entity discount rate is currently $189,537.
Yes
No
I understand that I can choose not to answer, however, I will not be eligible for Micro Entity Status.
Unsure
Are you under an obligation to assign, grant, or convey a license or other ownership to another entity that does not meet the same income requirements as the inventor?
*
Yes
No
Unsure
Is there more than one inventor?
*
Yes
No
Joint Inventors
Second Named Inventor
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Middle
Last
Suffix
Are you 65 or older?
*
Yes
No
Phone
*
Inventor No. 2 Email
*
Enter Email
Confirm Email
Residential Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Mailing Address
*
Same as previous
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Citizenship
*
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
United States
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Reduced Fee Status
We are dedicated to helping independent inventors and small businesses assert Small Entity Status or Micro Entity Status, allowing them to pay a fraction of the regular amount for most governmental fees.
Are you either an independent inventor or a non-profit organization?
*
Yes
No
Unsure
Do you have more than 500 employees?
*
Yes
No
Unsure
Have you assigned, granted, conveyed, or licensed any rights in the invention to any person who made it and could not be classified as an independent inventor, or to any concern which would not qualify as a non-profit organization or a small business concern?
*
Yes
No
Unsure
Are you named on more than four previously filed applications? Do not count Provisional Patent Applications.
*
Yes
No
Unsure
Does the inventor have a max. gross income of more than $189,537 for the preceding calendar year the application fee will be paid?
*
The "Maximum Qualifying Gross Income" for purposes of paying any eligible fee at the micro entity discount rate is currently $189,537.
Yes
No
I understand that I can choose not to answer, however, I will not be eligible for Micro Entity Status.
Unsure
Are you under an obligation to assign, grant, or convey a license or other ownership to another entity that does not meet the same income requirements as the inventor?
*
Yes
No
Unsure
Joint Inventors 2+
*
Are there more than two inventors?
Yes
No
Inventor's Notes
Invention Title
When did you first come up with the idea for your invention?
Date Format: MM slash DD slash YYYY
Have you built a prototype or model?
Yes
No
File
Please attach a copy of your engineering drawings, photographs, or sketches of your invention.
Drop files here or
Has a patentability search been performed on your invention?
Yes
No
Unsure
Are you interested in a formal Patent Search?
A formal Patentability Search is performed to assess if an invention meets the requirements of novelty, usefulness, and non-obviousness. The search is performed prior to the preparation of the Patent Application.
Yes
No
Please attach a copy of your search results.
Drop files here or
Accepted file types: pdf, doc, xls, .
Public Disclosure
The patentability of your invention may depend upon compliance with certain statutory time limits. Please be as accurate and complete in answering the following questions and attach additional sheets as needed.
Have you disclosed, made, used, sold, or offered to sell the invention to a third-party or commercialized the invention?
Yes
No
Unsure
When was the date of disclosure?
Date Format: MM slash DD slash YYYY
Has this invention been part of a "Provisional Patent Application" or a parent "Non-Provisional Patent Application"?
Yes
No
Unsure
Please provide the requested information.
Type of Patent Application
Date of Filing
Patent Application Number
Title of Patent Application
Record of Invention
Will you be assigning the rights of your invention to your holding company or to another entity?
Yes
No
Unsure
An assignment document can be recorded with the USPTO after the patent application has been filed.
Expedited Processing
Do you need a "Patent Pending" status within 2-4 weeks or sooner?
Yes
No
Unsure
Are you interested in Accelerated Examination of your application?
Yes
No
Unsure
From the patent application filing date, it typically takes approximately between 16+ months to receive a first Office Action from the USPTO. The USPTO has established procedures under which the examination of a patent application may be accelerated. Under one of these procedures, the USPTO will advance an application out of turn for examination if the applicant files a grantable petition to make special under the accelerated examination program.
Monitoring Due Dates
Do you want our firm to monitor your Patent Maintenance Fees?
*
Yes
No, I will be responsible for monitoring these dates.
Unsure
Once issued, your patent will require maintenance fees due to the USPTO at 3, 7, and 11 years from your patent issue date to avoid abandonment of your patent. Our firm can monitor these fees for you and contact you when the corresponding fees are due.
International PCT Application
Are you considering protecting your invention outside the United States?
*
Yes
No
Unsure
Detailed Description of the Invention
Describe the general field of the invention:
Attach any sketches, graphs or pictures that will aid in understanding the invention.
Drop files here or
Accepted file types: jpg, png, pdg, jpeg.
What are the primary objectives of this invention?
How does the invention operate?
Describe the structural components of the invention.
Any alternate embodiments?
What problems or drawbacks served as motivation for the invention?
What is the closest existing technology to the invention?
How does the invention improve upon the technology noted above?
Inventor or Assignee Signature
*
18 U.S.C. 1001 Statements or entries generally. Whoever, in any matter within the jurisdiction of any department or agency of the United States knowingly and willfully falsifies, conceals, or covers up by any trick, scheme, or device a material fact, or makes any false, fictitious or fraudulent statements or representations, or makes or uses any false writing or document knowing the same to contain any false, fictitious or fraudulent statement or entry, shall be fined not more than $10,000 or imprisoned not more than five years, or both. I declare under penalty of perjury that the foregoing is true and correct.
Date
*
Date Format: MM slash DD slash YYYY
Do you need to schedule your Initial Consultation?
*
Yes, I would like to schedule an Initial Consultation
No, I would like to submit this form only without an Initial Consultation
Initial Consultation
During the Initial Consultation the invention details and the patent process will be discussed in detail. The Initial Consultation fee of $150.00 will be applied to the Patent Application costs. Pre-pay is required to reserve your scheduled visit. If you need to reschedule your office visit, please do so at least 24 hours prior to your scheduled visit. If you do not reschedule your office visit or cancel your scheduled office visit at least 24 hours prior to your scheduled office visit, this will result in the $150.00 deposit being non-refundable. Cancellation deposit refunds are subject to credit card processing fees. You will be directed to Appointment Scheduling on the following page.
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