Invention Disclosure Form

Invention Disclosure Form

CAUTION: Please recognize that electronic transmissions can be monitored or intercepted by third parties, and use caution when considering transmitting any confidential and/or proprietary information over an electronic network. It is strongly recommended that the user first Encrypt and Zip with a password, multiple files containing any confidential information, first, and then choose and upload below the Zipped and Encrypted File, and then only include minimal, identifying information, which does not contain any confidential content, required information is noted below in a red asterisk(*).
Any submission will be sent electronically to, and maintained in confidence using reasonable efforts by: Ralph P. Albrecht, Esq., ATFirm PLLC, rpalbrecht@atfirm.com, 703 264-2220 D.

Please note any required fields are noted with a Red Asterisk (*).

NOTE: Please note that you may have to turn of Ad Blockers or Popup Blockers that may prevent entry of a Captcha. The Disclosure Form has been tested and works on Internet Explorer, as well as Chome when Ad Blockers are turned off.

Please Acknowledge that you have Read and Consent to the Disclaimer *

I have read and consent to the below linked disclaimers and agree to abide by the site's Terms of Service and consent to its Privacy Policy

Disclaimer

First Inventor Name *

First

Last

Residence City, State *

Second Inventor Name *

First

Last

RESIDENCE CITY, STATE *

Third Inventor Name *

First

Last

RESIDENCE CITY, STATE *

Approximate Date (MM/DD/YYYY) of Conception *

APPROXIMATE DATE (MM/DD/YYYY) OF REDUCTION TO PRACTICE *

FOURTH Inventor Name *

First

Last

RESIDENCE CITY, STATE *

Choose Any That Apply *

Never Disclosed Planning to Publicly Disclose on Already Publicly Disclosed on

Date *

Assignee/Owner/Company Name *

Company Address *

Line 1

Line 2

City

State

Zip Code

Country

Contact Email Address *

Contact Phone Number *

Upload Disclosure File *

Max file size: 20MB

Title for Invention *

SIZE OF COMPANY ENTITY *

Micro Entity Small Entity (<500 Employees) Large Entity (>500 Employees)

See FAQ re: Small Entity and Micro Entity Requirements

Select One (Patent Application Type) *

RELATED ART - CONVENTIONAL SOLUTIONS & THEIR SHORTCOMINGS *

Background Information (Field of Invention) *

Summary of the Invention *

BRIEF DESCRIPTION OF DRAWINGS (e.g., "FIG. 1 depicts a ...") *

Detailed Description of Example Embodiments *

Points of Novelty / Claim Features and Elements *

ESignature of Submitter (e.g., s/your name/) *

Date *

Abstract of the Disclosure (Needed for Conflict Checks) *

Submit

InventionDisclosureForm

Invention
Disclosure
Form