Invention Patenting Group
Confidential Invention Disclosure Form
Part I. Basic Information
1. Invention Title.
*
(Note: Please enter a descriptive title which describes your invention)
2. Primary Inventor.
*
First Name
Last Name
3. Address of Primary Inventor.
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
4. Phone Number of Primary Inventor.
*
Please enter a valid phone number.
5. Email of Primary Inventor.
*
example@example.com
6. Names of Any Additional Inventors.
7. Prior Use, Sale or Publication. (Identify any past use, sale, display or publication of the invention and include dates.)
8. Related Patents or Applications. (List any related patents or patent applications of yours.)
Part II. Disclosure of Invention
9. Purpose. (State the purpose or why you came up with the invention.)
*
10. Prior Existing Technology. (Describe the previous old methods, materials or apparatus used by others to perform the purpose of the invention and give their limitations/disadvantages.)
11. Physical Structure. (Describe the physical structure of your invention - if applicable. Photos and images of sketches or other illustrations to fully illustrate your invention should be uploaded below. In this description of the physical structure, use reference characters to refer to components in any uploaded illustrations.)
12. Upload File(s). (Scanned Image files or photos files only.)
13. Operation/Function/Use. (Give a detailed description of the invention's operation, function and use.)
*
14. Alternatives. (Indicate any alternative methods, materials, or apparatus of the invention.)
15. New Features. (Identify all of the features of the invention believed to be new and unique.)
16. Advantages. (State the advantages of the invention over the Prior Existing Technology described in item 10 above.)
Part III. Person Submitting This Form
(Fill out items 18-21 only if a different person than the Primary Inventor)
17. Form Submitter. (If Primary Inventor.)
18. Form Submitter. (If other than Primary Inventor.)
First Name
Last Name
19. Address of Form Submitter. (if other than Primary Inventor.)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
20. Phone Number of Form Submitter. (If other than Primary Inventor.)
Please enter a valid phone number.
21. Email of Form Submitter. (If other than Primary Inventor.)
example@example.com
Submit
Should be Empty: