Confidential Disclosure Form

Record of Invention for George L. Williamson, Patent Attorney.
Mr. Williamson will keep all information provided herein strictly confidential.
After completion, mail or fax this form to George L. Williamson, Patent Attorney. Post Office Box 508, Fairhope, AL 36533; FAX: 251-928-2539.

Use this form to organize your thoughts about, disclose, and make a record of your invention. Take time to fully complete the form and provide as much information as possible. Describe specifically what makes your invention different from the prior
art. Avoid general statements that your invention is “better.” Please explain why it is better, and what part of the invention makes it better? If you use any unusual terms, explain them. Describe how the parts work together. Do whatever you feel is
necessary in order to explain your invention in such a way as to make it clear to one who is not familiar with it.
Attach Drawings or Photos as separate pages.

Answer with N/A if an item is not applicable.
Attach extra pages whenever necessary.

Name of Inventor(s):_____________________________________________

Your Address:__________________________________________________

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Your Telephone:________________________________________________

Your Fax:_____________________________________________________

Your E-mail:___________________________________________________

Name of Invention:______________________________________________

1. Brief Written Description: Attach separate pages if necessary to give a complete Description. Describe the invention in general terms. What does it do? How does it do it? Attach drawings or Photos.

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2. Sketches of the Invention: If possible, use labeled sketches or drawings to show the details of your invention. Be sure all essential parts are shown on the sketches, and try not to include extraneous details. Measurements are not required, unless they are essential to the operation of the invention. Attach all drawings as separate pages.

3. Alternatives: Assuming you have described the best way to build (or perform) your invention, now, consider the alternatives. That is, how could the parts (or steps) be changed or equivalent parts substituted without changing the basic invention? Show drawings of the alternatives.

4. Date of Invention: “Invention” means a combination of conception (coming up with the idea of the invention) and reduction to practice (building it, or applying for a patent).

Conception: When did you first begin to work on the invention?

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Reduction to Practice: Has the invention been built? If so, when?

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5. Publications: Has the invention ever been described in any printed form, by anyone? If so, where and when?

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6. Prior Filings: Have you filed a Provisional Patent Application on this invention, or has there been an application for patent in the USA or elsewhere?

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Type of Filing:__________________________

Date of Filing:__________________________

Serial Number:_________________________

Where filed:___________________________

7. Public Use: Has the invention ever been shown or used in public? If so, where and when?

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8. Prior Sale: Has the invention ever been sold? If so, where and when?

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9. Age and Other Inventors: Is any inventor 65 or older? Is there anyone else who contributed to the conception or reduction to practice of the invention, in more than a purely mechanical way?
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10. Any additional notes or comments? Add anything you feel is important.

Signed: _________________________

Dated:__________________________

After completion, mail or fax this form to George L. Williamson, Patent Attorney. P.O. Box 508, Fairhope, AL 36533; FAX 251-928-2539.

(Optional). You may want to have this form witnessed or notarized if you are using it as a Record of Invention.

Witness No.1. Read, witnessed and understood:

_________________________ (signature)

Date:_________________

Witness No.2. Read, witnessed and understood:

_________________________ (signature)

Date:_________________