Invention Disclosure Form



		INVENTION DISCLOSURE Title of Invention: Name of Inventor A: Address: Citizenship: Telephone: Fax: E-mail: Name of Inventor B: Address: Citizenship: Telephone: Fax: E-mail: Name of Inventor C: Address: Citizenship: Telephone: Fax: E-mail: Name of Inventor D: Address: Citizenship: Telephone: Fax: E-mail: List as inventor anyone who contributed to the conception of the invention, but not individuals who merely supervised or carried out instructions. Brief Description Describe the invention in general terms: What does it do? How does it do it? Details of the Invention: What parts (steps, if a method) make up the invention, in its best (preferred) form? What does each contribute to the invention? Which parts are new to this invention (in form or usage), which are old (conventional, used in the expected way)? In what way do the parts interact to make the invention work? If possible, attach assembly drawings, sketches or flowcharts to detail your invention. Alternatives You have described the best way to build (perform) your invention. Now consider the alternatives. Structural Alternatives: In what ways could the parts (steps) be changed or equivalent parts substituted without changing the basic invention? Could the functions of any of the parts be changed, combined, eliminated? What could be added to make the invention work better? What could be left out? Limitations: When will the invention not work? Are there any critical ranges of size, weight, pressure, etc. for any of the parts of your invention? Must some parts be made of specific substances? (i.e. "the wall must be formed of plastic with a thickness of at least 2 mm") State of the Art: Consider what was already in existence (whether patented or not) before the invention. How is the function of the invention being done today? What companies or devices compete in the invention market? What is the closest device (method) you are aware of to your invention? What is the closest printed disclosure (such as a patent publication) you are aware of to your invention? How does your invention perform its function different from, or better than, these prior devices (methods)? Date of Invention: "Invention" means a combination of conception (coming up with the idea of the invention) and reduction to practice (building it, or applying for a patent). Conception: When did you first begin to work on the invention? Reduction to Practice: Has the invention been built? If so, when? Publications: Has the invention ever been described in any printed form, by anyone, or is publication planned in the future? If so, where and when? Prior Filings: Have you filed a Disclosure Document or Provisional Patent Application on this invention, or has there been an application for patent in the USA or elsewhere? Type of Filing: Date of Filing: Serial Number: Where filed: Public Use: Has the invention ever been shown or used in public, or is showing planned in the future? If so, where and when? Sale: Has the invention ever been sold or offered for sale, or planned in the future? If so, where and when? Rights in Others: Are you under any obligation to assign any rights in the invention to others? Was the invention developed in the course of a consulting agreement with someone else? If so, did you agree that any inventions belong to them? Was there any funding of the development of the invention by any party (government agency, school, etc.) who might claim rights in the invention? Was any equipment or facilities used in the development of the invention which was funded by or belongs to any government agency? Please sign and date. Signed, Inventor A: _________________________ Dated: Signed, Inventor B: _________________________ Dated: Signed, Inventor C: _________________________ Dated: Signed, Inventor D: _________________________ Dated: Management Consideration What is the potential annual market for this invention? Is the company planning to commercialize the invention? Rate, from 1 to 10, the extent to which the invention is critical to sell into that market? Can the invention be protected, while selling the invention, by trade secret? What other barriers to market entry exist, that might prevent competitors from copying the invention? Can the invention be promoted as a selling feature to customers or potential investors? Approved for provisional filing _________________________________ _________________ Signed Date Approved for non-provisional filing _________________________________ _________________ Signed Date Approved for foreign filing _________________________________ _________________ Signed Date

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