Provisional Application Request Form Who is filling out this form? Are you, the person filling out this form, one of the inventors? * Yes No An inventor is anyone who contributed to the way this invention works. The USPTO wants the actual inventors listed, even if ownership is later assigned to a company or another person. Inventor Information First Name * Last Name * Middle Name Email * Phone * City * State/Province * Country * Mailing Address Street Address * Street Address 2 City * State/Province * Postal Code * Country * Assignment Will the invention be assigned to a company or other third party? Yes No If yes, who will the invention be assigned to? Assignee Type Company Individual University Other Please Tell Us About Your Invention Proposed Title of the Invention * General Description of Invention * Relevant prior art patents or products What specifically is new about this invention compared to the prior art? * What do you consider the core feature of the invention? * Optional or secondary features Date first publicly disclosed or offered for sale * Enter N/A if the invention is still secret or was only disclosed under confidentiality. If you filed a provisional or related patent application, when? Application number, if known Drawings, Sketches, Photos, Prototypes Drawings/CAD Photos Sketches Prototype Upload drawings, sketches, photos, prototypes, or other files You may upload drawings, photos, Word docs, PDFs, CAD screenshots, or other helpful files. Special Circumstances Inventor is age 65 or older or suffering from a terminal illness Invention made with government aid I/we plan on filing foreign patents Do NOT publish at 18 months Type of Patent Application Provisional Application — $899 Estimated preparation timeline: 1–2 weeks after receiving the completed form and all requested information/files. USPTO Entity Status / Government Fee Select your entity status * Micro Entity — USPTO fee: $65 Small Entity — USPTO fee: $130 Large Entity — USPTO fee: $325 Entity status affects the government filing fee. Select the best option based on your circumstances. Additional Details Anything else relevant? MeilanderIP Provisional Application Fee$899 USPTO Government Filing Fee$0 Total Amount Due$899 Agreement I am authorizing payment of the fees listed above, the information above is true and complete to the best of my knowledge, and I agree with the terms. Submit Request