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Inventor(s):     (Enter Your Name Here)

Address(es):    (Enter Your Address Here)

Telephone Number(s)  (Enter Your Telephone Here)

e-Mail Address(es)  (Enter Your Email Here)

Title of Invention:       (Enter Your Invention Name Here)


While some of the information on this form will not be applicable to every invention and sometimes all of the information requested will not be available to the inventor, a conscientious effort should be made to complete this form as completely as possible.  Do not limit answers to the space provided.  Feel free to include as many pages of disclosure as necessary, including drawing figures, graphs, charts or other data compilation(s), spreadsheets, or photographs, to meet your requirement of teaching how to best use, make and appreciate the invention, and the best mode to practice the invention.  35 U.S.C. § 112

Circumstances of Conception.   [When and where you first thought of the invention].    (Enter Your Date and Name of Street Address Location Here)

Laboratory notebook pages on which this disclosure is based.  SolidWorks CAD

Date of first drawing, if any, illustrating the invention. (Enter Your Date Here)

Date of first written description of the invention.  (Enter Your Date Here)

To whom was the invention first disclosed? (Enter Your Name Here) and Chris  Andrews (Cad Designer)

What was the date of first disclosure?   (Enter Your Date Here)

When did you first do experimental work toward carrying out the invention? (Enter Your Date Here)

When were you first satisfied that you had solved the problem toward which your invention was directed?(Enter Your Date Here)


Who observed the progress of your experimental work?  (Enter Your Name Here)


Purposes and advantages of invention. [Complete description of the advantages, improvements, business method, safety, etc. offered by the invention over existing or prior art B please use additional pages to answer this and any subsequent disclosure questions].    (Enter Your Purpose or Advantage Here)


Description. [Complete description of the invention by all individual component parts, including, but not limited to, block diagrams, logic flow diagrams, e-commerce building blocks, formulas, algorithms, equations, and the like].  (Enter Your Description Here)



Drawings. [Complete drawings showing the invention, the method, e-commerce building blocks, logic and program flowcharts (using ISO flowchart standards where applicable)].  See SolidWorks CAD DXF and PDF multi sheet, or see below:  (Enter Your/Our Drawings Here)

Ramifications. [Include any alternative combinations or substitute components for the invention]. (Enter Your Ramifications Here)

Possible novel features. [List any component or combination of components in the invention that is believed by you to be novel].  (Enter Your Novel Features Here)

Closest known prior art. [Refer to or list any known components or assembly of components within the invention found in commerce or literature (prior art), including, but not limited to, any prior art novelty or patentability searches conducted, relevant technical literature, and the like].  List all prior patent (including patents of your Company, if applicable) and published articles of which you are aware that are related to this invention.  (Enter Your Comparison Here)

Statement of the problem the invention solves. (Enter Your Remedy Here)

Statement of what had been done previously in the art to solve the problem. (Enter Your Predicate information Here)

Statement of how this solution [your invention] is better than the prior art. (Enter Your Solution Here)


Any previous disclosure of conception. [Describe when and where it took place].  (Enter Your Location Here)

Construction. [Describe when and where you constructed proto-types or working models of your invention].   (Enter Your Location Here)

Ramifications.  [Include any alternative combinations or substitute components for the invention as a result of knowledge gained in constructing the proto-type(s) or model(s)]. (Enter Your Location Here)

Tests. [Describe any tests, giving date(s) and location(s) for each such test]. (Enter Your Location Here)

Test results.  [Describe the results of tests, giving the data, graphical representations thereof, date(s) and location(s) for each such test].  (Enter Your Location Here)


Has the invention been sold or offered for sale or license?  If so, when, and where?  (Enter Your Response Here)

Has the invention been described in a printed publication or at a public forum including, but not limited to, doctoral thesis?  If so, when and where? (Enter Your Response Here)

Has the invention been used in public?  If so, when and where?  (Enter Your Response Here)

Was the invention known or used by others in this country before invention by the applicant(s) in this disclosure?  If so, when and where?  (Enter Your Response Here)

Was the invention patented or described in a printed publication, in this country or in a foreign country, before invention by the applicant(s) in this disclosure?  If so, when and where? (Enter Your Response Here)

Is the invention the subject of assignment by virtue of contractual employment terms or similar instrumentality?  If so, please provide a copy of the assignment provision.

Inventor(s) ___________________________ (Enter Your Signature Here)    Date: ____________ (Enter Your Date)

Inventor(s) ___________________________(Enter Your Signature Here)    Date: ____________ (Enter Your Date)

If the above described and detailed invention will be owned by or assigned to a legal entity, please identify the entity by name:  (Enter Your Associate Legal Entity Here)

Please describe the type of entity (i.e., stock corporation, Sub chapter-S corporation, partnership, Limited Liability Company, or such), the Date and State of Formation, and the physical address of the entity’s principal place of business.  (Enter Your Entity  Name Here)

Please provide the authorized officer for the above identified entity who will serve as the liaison for all legal matters and billings for the entity, and include that identified officer’s direct telephone number, email address, and postal mailing address:  (Enter Your Associate Legal Entity Location Here)

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