Millionaire Inventor Project

Invention Patenting Group

New Client Intake Form
1. Client Information
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*
In general, what days and times of day are best to contact you by phone with questions or to have your mentoring sessions?*
2. Confidentiality
Would you like me to sign a Confidentiality Agreement regarding the details of your invention? If not, I still will keep your invention confidential except as necessary and approved by you to disclose to select people to develop your invention.*
3. Invention Information

If you are not comfortable disclosing the following information now and want a signed Confidentiality Agreement first, you only need to answer the questions that have a red asterisk *. You can name your invention in generalities for purposes of this form.
What is the name of your invention? If you don't have an invention, please enter "none". If you have multiple inventions enter the name of the invention you most likely want to develop into a marketable product.*
When did you conceive (think of) your invention? If you don't have an invention, please enter "n/a".
Are you the sole inventor or a co-inventor?
If you are a co-inventor, who are the co-inventors besides you?
Have you kept your invention confidential (not told or showed other people without a signed Confidentiality Agreement)?
If you have not kept your invention confidential, to whom have you disclosed it and for what purpose?
What is your goal for the invention?*
At what stage of development is your invention (select all applicable)?*

IdeaPrototypePatent PendingPatentedLicensingTooling / Pre-ProductionProductionOther
If you have any questions related to this form, please write them here.
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Invention Patenting Group

1. Client Information

2. Confidentiality

3. Invention Information