Newco, Inc.page 1Invention Disclosure Form
INVENTION DISCLOSURE
1. Description of the Invention
Please describe specifically what you consider to be your invention, as distinct from the prior art. If necessary, use additional pages, drawings, diagrams, etc. Description may be by reference to a separate document (copy of a report, a preprint, grant application, or the like) attached hereto. If so, identify the document precisely. Each separate page or document should be signed, dated, and witnessed. as below:
2. Inventor(s): Name, position, address, telephone number, email.
(a)
(b)
(c)
3. Assignment: The assignee of the invention will be:
Newco address goes here
4. Title of Invention:
5. Background:
(a) What is the field or art to which the invention applies?
(b) Describe the closest older method, apparatus or product known to you:
(c) If you can, please identify, and if available please attach, references from the prior art by patent number, journal article citation, catalog or data sheet:
(d) What is the deficiency in the prior art which your invention improves upon, or the limitation which it extends?
6. Does there exist an earlier, dated record of the invention's conception - a sketch, report, laboratory notebook entry, or the like - which: a) describes your invention, and b) can be independently corroborated? If so, what is it and where is it?
7. Has your invention or any method or apparatus using your invention been:
(a) described in a publication? (where, when)
(b) publicly used or demonstrated? (where, when)
(c) offered for sale? (where, when)
8. Commercial Value and Impact
(a) What do you see as the commercial value of the invention?
(b) What firms do you think may be, or are, interested in it, and why?
9. Being for the moment the Devil's Advocate, what do you see as the greatest obstacle to the adoption of your invention?
10. Is further development of your invention now in progress? Scheduled? Dependent on commercial or Federal sponsorship?
11. Identify funds which were used in making the invention; for example, Federal funding by grant or contract or funding by a corporation:
READ AND UNDERSTOOD BY:
Inventor(s)______Witness:______
______
Date: ______Date: ______