Patent Prosecution Short Intake Form Are you making your filing as an individual or on behalf of a business?IndividualBusinessName First Last Contact Name First Last Email CompanyState of Formation (if known)Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Choose the description that is the closest match to your invention.An invention related to the use or function of an object or a method of accomplishing something (e.g. an energy saving lightbulb, a new data processing method)A set of decorative features for a useful object (e.g. a carved shovel handle, flower shaped flowerpot, etc...)A new breed or variety of plant (e.g. roses with unique coloration, drought resistant crops)What problem does your innovation solve? What technical or business field is your innovation drawn from?What would you consider the closest existing competitors or relevant products for comparison with the invention?Is your plan for this patent to be owned by you or another person individually, or for the patent to be owned by a business entity?IndividualBusinessBusiness (not formed yet)Are you an Inventor, or an Applicant who has or will obtain patent rights from the Inventor(s)? (To be an Inventor, you must have conceived of a feature of the claimed subject matter of the invention. An individual involved in development of the invention may not be an Inventor if they did not conceive of an original feature to be covered and merely assisted in building or testing the idea. If you are unsure if a potential Inventor should be listed, list their name and a determination can be made during the consultation. Business entities cannot be Inventors, but Inventors can be obligated by contract to assign their rights to a business entity who becomes the Applicant.)I am the sole InventorI developed the Invention with the assistance of other InventorsI am the Applicant or representing a business entity who is the ApplicantAre you a US citizen? If not, or if you have dual citizenship, please list the nation(s) where you have citizenship.What is your county of residence?Please provide the name, contact address, county of residence, and citizenship of each potential Inventor, if known.Has the invention been disclosed publicly. If so, when? (A public disclosure occurs when the invention is described in a printed publication, placed in public use, or offered for sale without steps taken to maintain confidentiality. Discussion of the invention in a public setting may also count as disclosure.)What are your goals for obtaining patent protection? (e.g. known competitors, national/international expansion, entrance into market/new market, attracting investment, litigation)NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.