Invention Disclosure Form

	DATE FORM RECEIVED
	 FILE NO.
	
INSTRUCTIONS: Fill each blank with the requested information or enter "NONE" as appropriate. Where space on the form is inadequate, enter "see attached page" and use plain pages as needed. When completely executed, this form becomes an important legal document useful in proving priority of invention. 	
PART I. BASIC INFORMATION
1a. DESCRIPTIVE INVENTION TITLE. 

1b. INVENTOR(S)	
MAILING ADDRESS	
TELEPHONE	
E-MAIL ADDRESS	

	

	

	

	

	

	

	

	

1c. OWNER.  Do the above inventor(s) own the patent rights to this invention (check one)? [ ] Yes  [ ] No   If you answered "No," please identify the owner of the invention below including the state/country of organization for the company along with the company's mailing address.

1d. PRIOR USE, SALE OR PUBLICATION. Identify any past use, sale, display or publication of the invention (include dates).  

1e. RELATED PATENTS OR APPLICATIONS. List any related patents or patent applications of yours.

	
PART II. DISCLOSURE OF INVENTION	
2a. PURPOSE.  State the purpose of the invention.

	
2b. 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.

	
2c. PHYSICAL STRUCTURE.  Describe the physical structure of your invention (if applicable).  Sketches, photos, or other illustrations should be attached to this form to fully illustrate your invention. In the description of the physical structure, use reference characters to refer to components in attached illustrations.

	
2d. OPERATION/FUNCTION/USE. Give a detailed description of the invention's operation, function and use. 

	
2e. ALTERNATIVES. Indicate any alternative methods, materials, or apparatus of the invention.

	
2f. NEW FEATURES.  Identify the features of the invention believed to be new.

	
2g. ADVANTAGES. State the advantages of the invention over the Prior Existing Technology described in paragraph 2b.

	
PART III. PERSON SUBMITTING FORM	
FULL NAME
	SUBMISSION DATE
	
MAILING ADDRESS
	BUSINESS TELEPHONE	
E-MAIL ADDRESS
	CELL PHONE
	
      NLO (11/09)