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Inventor's Address:

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Co-Inventor's Name: (optional)

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1) What is the Name and Title of your Invention?

2) Using as much detail as possible, please describe your invention and the problem it solves:

3) Please provide amateur drawings or cell pictures here or email to the firm (optional)

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4) Is it currently under testing? (Describe where, what who and how?)

5) Is there presently a provisional patent filed?

6) Do you have any inventor’s certificates or patents - granted or pending in any country?

Yes

7) Are you a micro entity? (Less than 500 employees in company or company affiliates)

Yes

8) Is this application being assigned? To whom?

9) Are you under any agreement to assign this invention?

Yes

10) Are you going to show your invention at a trade show or to attempt to sell it? When?

11) Have you used your invention in public or shown it to anyone else? Who and when?

12) Have you published anything regarding your invention anywhere? When?

13) How many different embodiments (models) do you have?

14) Describe the drawbacks, inadequacies limitations, requirements, or specific complications that now exist in the prior art.

15) Regarding this invention and field of art, describe how things have been done traditionally in the past?

16) Describe what you think are the new and novel concepts of your invention?

17) How urgent is the filing of this patent?

18) Does your invention or the inventor fall into the following categories? If so, please place a (√ ) next to the applicable categories (as the application may qualify for expedited processing by the USPTO). (optional)

1G Manufacture Available*

2G Infringement Exists*

3G Applicant’s Health is Poor

4G Applicant’s Age > 65

5G Environmental Quality

6G Energy Savings

7G Recombinant DNA is Involved*

8G Special Procedure - Search was Made*

9G Superconductivity is Advanced

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