City, State, Zip s4

Date:

Name:

Street:

City, State, Zip:

Telephone Number:

Email:

(If you do not wish for any of the personal information above to be published on the Internet, please type the contact information you DO NOT want published below:

Website (if you have one):

Name of my invention:

The invention is covered by patent number:

The invention has a patent pending status (Yes/No):

I have read and agree with the disclaimer (Yes/No):

Below, please type the sales/marketing description of your invention you want to be published on your webpage (not to exceed approximately 350 words, and do not use all caps or no caps). Use a second page if necessary, or attach advertising material. If you want to use the abstract from your published patent, type: “Use abstract”. It is helpful to state whether you are in production or if a prototype is available, and if you are seeking store buyers, licensees, manufacturers, distributors, or investors, etc.