Invention Disclosure Form

Disclosure - Invention Submission Form

Complete each section to the best of your abilities. To ensure the security of your data, you will not be able to save the data entered and come back to the website at a different time (i.e. we do not receive or store your data until you successfully submit the form to us and you must complete your provisional application after starting it). It is recommended to copy/paste/save any significant amounts of information as you type the same into this form to a separate document as a backup in case you have technical problems with your browser and/or form. If you have any problems with using this online form or if you have more data to enter than will be accepted by a field, please contact us immediately at (Enable Javascript to see the email address) or 810.208.0968.

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Descriptive Invention Title:*
Invention Made Under a Contract with or by a U.S. Government Agency?*
- No
- Yes
Name of U.S. Government Agency and Government Contract Number
Number of Inventors
Inventor Name
Prefix First Last Suffix
Phone*
Contact Email Address*
Enter Email Confirm Email
First Inventor Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
First Inventor Citizenship:*
Second Inventor
Prefix First Last Suffix
Second Inventor Address
Street Address City State / Province / Region ZIP / Postal Code Country
Second Inventor Citizenship
Third Inventor
Prefix First Last Suffix
Third Inventor Address
Street Address City State / Province / Region ZIP / Postal Code Country
Third Inventor Citizenship
Fourth Inventor
Prefix First Last Suffix
Fourth Inventor Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Fourth Inventor Citizenship
Fifth Inventor
Prefix First Last Suffix
Fifth Inventor Address
Street Address City State / Province / Region ZIP / Postal Code Country
Fifth Inventor Citizenship
Overview of Invention
In this section, you will be asked to provide an overview of your invention to the best of your abilities. Do your best in completing each section and if you can't complete a section simply indicate "Not Applicable" or "Insufficient Information."
Object of Invention
Quick 1 or 2 sentences describing a use or function of the invention, e.g., "The purpose of the invention is to catch mice."
Brief Description of Invention (3-5 Sentences)
Briefly describe the invention and how it operates/functions.
Description of Problem(s) Solved or Improved by Invention
Describe problems(s) or shortcomings of current technologies, and how your invention solves these problems.
Advantages and Benefits of Invention
Describe the benefits users would receive from using the invention.
Upload Drawing Document
Accepted file types: pdf, doc, jpg, docx, ppt, pptx, Max. file size: 8 MB.
Alternatively, drawing illustrations may be emailed to: (Enable Javascript to see the email address)
Description of the Components of the Invention
Provide a detailed description for each of the elements of your invention using the reference numeral after each element name (e.g. trap 10, mouse 20).
Description of How the Invention Operates/Functions
Describe in detail how the invention operates/functions and how each of the individual elements operates/functions.
Unique Aspects/Features of Invention
Describe in detail all of the aspects, structures and/or functions of your invention that you consider unique compared to known technologies.
Alternative Embodiments (Optional)
Identify any alternative configurations, structures, materials or methods of operations that could be used for your invention other than described above.
Comments and/or Instructions (Optional)
Let us know your comments and/or instructions relating to your provisional patent application.
Name of Person Submitting Form*

Enter Your Full Legal Name