The purpose of this Patent Questionnaire is to (1) clarify the invention; (2) create a legal document recording the date of invention; and (3) facilitate a higher quality and less expensive patent application.

Generally, the following major pieces of information will expedite patent prosecution. 

            (1)    Drawings or photographs of the invention (preferably labeled with numbers for important parts).

             (2)       A written description referring to the drawings/photographs and identifying:

                                    how the invention works;

                                    how the invention is made; and

                                    what parts make the invention better than existing devices and why.

            (3)       The above information should be read, signed and dated by the inventor.  Further, a non-inventor should read the document, witness the inventor signing the document and sign the document "read & understood by ______________ ___________________ on __/__/__."

The following pieces of specific information are necessary for efficient patent prosecution (attach additional pages as necessary).

1.                   Name, residence address and citizenship of inventor(s).  Include as inventor     
            everyone who contributed to conception of invention.
            (1)___________________________________________________________________
            (2)___________________________________________________________________
            (3)___________________________________________________________________

2.                   Title of invention.  ______________________________________________________

3.                   Date invention conceived.  _______________________________________________

4.                   Date invention first successfully tested.  ____________________________________

5.                   Names of persons with knowledge of testing.  _______________________________

6.                   Was invention disclosed outside of company?  If so, give date(s) and/or title. 
                                                                                                                                           
            ____________________________________________________________________

7.                   Date of first commercial use, sale or offer for sale.  __________________________

8.                   Describe old methods or apparatus and indicate disadvantages.  
            ____________________________________________________________________
            ____________________________________________________________________
            ____________________________________________________________________

This is not a substitute for legal advice.  An attorney must be consulted.
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9.                   Describe the problem your invention fixes. _________________________________ 
            ___________________________________________________________________
            ___________________________________________________________________
            ___________________________________________________________________
            ___________________________________________________________________

The following pieces of specific information are necessary to perform a cost-benefit analysis with regard to patent protection.

13.               Is the invention/product central to Company's present business? _____

14.               Is the invention/product central to Company's future business? _____

15.               Can invention be used/sold without competitors gaining knowledge of invention? _____

16.               How important is invention toward sales, as viewed by consumer? _______________

17.               Estimate yearly sales of invention/product:

                        Units:                                      

                        Dollars: