You should answer the following questions as accurately as possible. A Z Patent will return your an initial non-binding opinion concerning the chance to get a patent for your invention.If you get a negative opinion, it merely means that A Z Patent will not take your case. If it reaches a positive opinion,it will consider our the case. Whether you will get a patent eventually depend upon whether your invention fall within any class of patentable subject matter; whether your invention is INDEED new, useful, and non-obvious; and whether or not your invention is barred for missing filing deadline.

1. Please provide your names and street address where A Z Patent can reach you.

   Name:	Title:
   Organization:
   Address:
   City:	State: AL AK AR AS AZ CA CO CT DC DE FL GA IA ID IL IN KS KY LA MA MD ME MI MN MS MO MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VI VT WA WI WV WY Zip Code:
   Country:
   Phone:	Fax:
   E-mail:

2. When did you conceive the invention that was proved successful?

   Conception Date: -- mm/dd/yy

3. In which country did you conceive your invention?

4. When did you reduce to practice your invention?

   Date invention completed: -- mm/dd/yy

5. In which country did you reduce to practice your invention?

6. At the time you conceived your invention, did you know if any person had already invented the same or a substantially similar invention?>

   Yes No

7. At the time you reduced to practice your invention, did you know if any person had already invented an identical or substantially similar invention?

   Yes No

8. Please describe usefulness (utility) of your invention. Please be specific.

9. Did you publish any article that describes your invention more than a year before the earliest day you can possibly file your first patent application in the United States?

   No Yes
   
   The Publication Date: -- mm/dd/yy
   
   The Journals:
   
   

10. Did you see any published article that describes a product or process identical or substantially similar to your invention?

    No Yes
    
    The Publication Date: -- mm/dd/yy

    The Journals:

    How is the invention described in the publication related to yours?

11. Did you see any process or product identical or substantially similar to your invention?

    No

    Yes

    When: -- mm/dd/yy

    Countries:

    How is the invention you saw related to yours?

    
    

12. Have you sold or offered to sell products or services using your invention in the United States or have you used your invention?

    No

    Yes

    When: -- mm/dd/yy

    Countries:

    Described in detail offers for sales, sales or uses.

    
    

13. Are you aware of any suggests in products, patents, journals or printed materials that directly or indirectly teach one to make your invention?

    No

    Yes

    When: -- mm/dd/yy

    Sources:

    Describe the suggestions in detail.

    
    

14. Did you get help from others in making your invention?

    No

    Yes

    Describe the help you have received in detail.

    
    

15. Does your invention fall within any of the following classes?

    Mathematical equation

    Products of nature in a form existing in nature

    Law of nature

    Natural species without human alteration

    Ideas or procedures that can be done purely by mental process

    Business method without involving machines or hardware

    Philosophy

    Scientific theories

    Perpetual machine

    None of above
    

16. Did you actually have any model of your invention that you can show to A Z Patent?

    Yes No

17. Are you interested in patents from other countries?

    No
    Yes
    Countries:

18. Please select a method for sending result to you.

    1. By email
    2. By US mail
    3. By telephone call

      By signing my name in the following box, I express my consent to the terms for using this service as stated at top of this form. I understand and agree that this service is provided solely for the purpose of conducting initial evaluation of my invention and is not intended to substitute legal advice.

Date: