Patent Client Intake Form

Patent Intake Form

Client contact information for engaging Clark & Bellamy’s patent prosecution legal services.

Formal Name of the Client*

The owner and contact person might differ. Identify the client here.

Address*

Street Address Address Line 2 City State ZIP Code

Email Address (Client)*

The client will enter a separate address for the primary contact person or employee if different than the client.

Entity Type (if applicable)

If the client is a business, please select an entity type.

Other Entity Type

State Organized (if LLC/Corporation, etc)

Land Phone Number (Client)

Mobile Phone Number (Client)

Fax (Client)

Contact Person is Same as the Owner?*

Yes

CONTACT INFORMATION

(IF DIFFERENT THAN THE CLIENT)

Name of Contact Person

Title of Contact Person

Email Address (Contact)

Land Phone Number (Contact)

Mobile Phone Number (Contact)

Street Address (Contact)

Apartment, suite, etc (Contact)

City, State, Zip (Contact)

Invention Information

Inventor(s) the same as*

Owner named

Contact Person

Other

An inventor is an individual who has contributed to the conception of one or more of the specific, inventive aspects of the invention as claimed in the patent application. An inventor may have contributed to the overall idea, the design, or a unique feature. It’s essential to list all individuals who have made such contributions. It’s not necessary for an inventor to have contributed to every claim of the patent application. If multiple individuals contributed, each person who has made a contribution to at least one claim should be listed as an inventor. Please add any additional inventors by clicking checking “other” to open a new list box.

List Inventor(s), Address of Residence, Citizenship

Please indicate if the owner or contact person is also an inventor.

BRIEF DESCRIPTION OF THE INVENTION*

Please provide a brief description the invention that you request Clark & Bellamy to provide patent prosecution services.

This field is hidden when viewing the form

Agreement

Agreement*

By clicking the Submit button below you electronically agree to Clark & Bellamy, P.C.’s website Terms of Use, Privacy Policy, and the Firm’s Patent Engagement Terms.

Click to Consent

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