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SAMPLE FORM

PATENT QUESTIONNAIRE

Purpose

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.

Overview

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 Gerald Klut¹on 04/02/05.¹”

Specific Information

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) Tony Charter 40 Cobler St. SE, Kwit, ID 83406, U.S. ²

(2) Henry Fox 2221 45th St. NE, Kwit, ID 83406, U.S. ²

(3) Carla Fox 2221 45th St. NE, Kwit, ID 83406, U.S. ²

2. Title of invention. Rowdy Ball ³

3. Date invention conceived. 03/30/05 ⁴

4. Date invention first successfully tested. 04/05/05 ⁵

5. Names of persons with knowledge of testing. Sarah Charter, Gerald Klut ⁶

6. Was invention disclosed outside of company? If so, give date(s) and/or title. No ⁷

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Copyright ©1994 - 2024 by LAWCHEK, LTD.

7. Date of first commercial use, sale or offer for sale. 04/10/05 ⁸

8. Describe old methods or apparatus and indicate disadvantages. Regular playing balls
can be destructive because they are too hard. ⁹

9. Describe the problem your invention fixes. Allows children to play indoors without damaging surroundings. ¹⁰

10. Generally describe invention (Attach pertinent drawings, photographs, sketches, test data, or flow sheets. Use additional pages if necessary). See attached sheets. ¹¹

11. Give details of its structure and/or operation, i.e., how it fixes the problem. Soft material does not disturb other objects when thrown. ¹²

12. State the advantages of the changed/improved features. None ¹³

FOR MANAGEMENT USE ONLY:

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? Yes ¹⁴

14. Is the invention/product central to Company's future business? No ¹⁵

15. Can invention be used/sold without competitors gaining knowledge of invention? No ¹⁶

16. How important is invention toward sales, as viewed by consumer? Significant ¹⁷

17. Estimate yearly sales of invention/product:

Units: 1,000¹⁸

Dollars: 5,000¹⁸

18. Estimate duration (in years) of market in invention/product. 5 ¹⁹

This is not a substitute for legal advice. An attorney must be consulted.
Copyright ©1994 - 2024 by LAWCHEK, LTD.

The above is an example of how a typical Patent Questionnaire form may be completed.

1. The full name of the witness of the document and the date it was read/understood.

2. The full name, address, and citizenship of the inventor(s).

3. The name of the invention.

4. The date the idea was first discovered.

5. The date the idea was first tested.

6. The full names of the others with knowledge of the inventions testing

7. The name of the company that was shown the invention before hand. The dates and the titles of the

product when it was shown.

8. The date the invention was first placed on the market.

9. Concise descriptions of old products that are similar but have disadvantages. State the disadvantages.

10. Describe the previous problem(s) your invention corrects.

11. A concise description of the invention. Attachments may be included.

12. Description of how the invention fixes the problem.

13. State any changed or improved features of the invention.

14. Answer Yes or No regarding the relationship of your invention to your Company.

15. Answer Yes or No regarding the relationship of your invention to your Company.

16. Answer Yes or No regarding the relationship of your invention to your Company.

17. Indicate the degree of importance of the invention to the user.

18. Estimate the number of inventions predicted to be sold and the amount to be earned.

19. Estimate the number of years the product will be on the market.

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This is not a substitute for legal advice. An attorney must be consulted.