Intellectual Property Intake Form

*Name:
Please enter your name.

*Address:
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City:

*State:
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*Zip:
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*E-mail address:
An e-mail address is required.Bad format (ex: name@domain.com)

*Home Phone:
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Business Phone:

Cellular or Pager:

Facsimile:

*What type of intellectual property does this matter concern?
Choose One Copyright Patent Trademark Trade Secret Please select a valid item.

This matter involves:
Choose One Infringement Prosecution Registration Theft of Secrets Other

Are you the sole owner or claimant of the property?
Yes   No 

If no, provide the name and address of the other owner or claimant, along with a description of their interest or claim in the property:

Does this matter involve the registration of a copyright, patent or trademark?
Yes   No 

If yes, provide the dates and places of any prior registration or attempted registration:

Does this matter involve a business you own or run?
Yes   No 

If yes, provide the business name, address, and phone:

Describe your situation, including any relevant dates:

How would you rate your legal needs described here?
Choose One Extremely Urgent Urgent Standard Informational Only

Are any other people involved?
Yes   No 

If yes, provide names, addresses (if known), and their relationship to you, if any:

Do you have any documents that could help explain your situation?
Yes   No 

If yes, list those documents and their dates:

Are there other documents that you do not have access to that could be of assistance?
Yes   No 

If yes, list those documents and their dates and locations (if known):

Describe how this situation has impacted you:

Describe what you would like to happen to resolve your issue (your preferred outcome):

Have other attorneys worked on this matter?
Yes   No 

If yes, provide names, addresses, and a brief description of their involvement:

Special concerns:

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