RICHARD A. RYAN
INVENTION DISCLOSURE FORM
(USE CONTINUATION SHEETS AS NECESSARY)
1. Inventor(s) - Full name (including middle initial), address and phone number and Nationality (i.e.,
U.S.A.):
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2. Will this Invention be assigned to a company or another entity?
( )Yes ( )No
If yes, Name of entity:___________________________________________
Type of entity (corp., partnership, etc.):_______________________
State of incorporation, partnership, etc.: ______________________
Address for entity: ______________________________________
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3. Title of Invention: ________________________________________________________
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4. Date when invention first thought of: __________________________________________
Is this date documented in writing? ( )Yes ( )No.
5. Has a working model been made? ( )Yes ( )No.
If so, when? _____________________________________________________
6. Has the invention been:
a. Offered for sale or sold? ( )Yes ( )No When? _________________________________
b. Described in a Publication? ( )Yes ( )No When? _______________________________
c. Publicly used/demonstrated? ( )Yes ( )No When? ______________________________
7. Background of the invention:
a. What is the problem solved by the invention?
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b. How was problem solved before the invention?
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c. Why does the invention solve the problem better?
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d. List or describe the closest related patents, publications
or products known.
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8. Describe the invention in detail:
a. What are its basic components?
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b. Which components are essential and why?
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c. How are the components connected or organized?
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d. How does it operate (function or steps)?
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e. How does someone use the invention?
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f. How does the invention accomplish its objectives?
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g. What limitations exist (i.e., temperature, quantities, sizes
or materials)?
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9. What variations (i.e., materials, components or functions) to
your invention are currently known?
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10. Additional pages attached:
a. ____ pages of continuation sheets for items above.
b. ____ pages of drawings, sketches, photographs and/or
documentary evidence of date of invention.
INVENTION DISCLOSURE FORM
CONTINUATION SHEET
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