Required Information

Today's Date: ____________________

Contact Information

Company: __________________________________________________________

Contact Person:______________________________________________________

Title: _________________________________________________________________

Type of organization and State where organized (e.g., New York Corporation)

______________________________________________________________________

Address:_______________________________________________________________

_______________________________________________________________________

Phone Number: _______________________ Facsimile: _______________________

E-mail: ________________________________________________________________

Invention Information

What is the date of conception of your invention: _________________________

Who was involved in the invention?

Name: ___________________________________

Name: ___________________________________

Name: ___________________________________

Name: ___________________________________

Has the invention been reduced to practice, i.e., built:

Yes. Date: ____________. No.

Has the invention ever been sold or offered for sale?

Yes. Date: ____________. No.

Has the invention ever been used in public or described in a printed publication?

Yes. Date: ____________. No.

Do you plan to publicly use or sell the invention soon?

Yes. Date: ____________. No.

Are you aware of any information (e.g., prior patents or printed publications) which may materially affect the patentability of the described invention?

Yes. Describe: _________________________________________________

_________________________________________________
No.

Do you intend on filing the application in a foreign country or internationally?

Yes.

No.
Allow to Publish.
Request No Publication.

Invention Description

What is the invention? ___________________________________________________

________________________________________________________________________

________________________________________________________________________

What problem(s) has the invention solved? ________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

How did the inventor(s) solve the problem? _________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

What have others done to solve the same problem(s)?

__________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

What is the best embodiment or mode of the invention?

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Fee received: _________________________ For: _________________________________

Hoffman Warnick LLC

By____________________________________ Date: _______________________________

The above-identified person(s) has received a copy of this Initial Client Consultation and Confidentiality Form.

______________________________________ Date: _______________________________
Inventor(s)/Applicant(s) Signature