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Intellectual Property Intake Form

*Name:

*Address:

*City:

*State:

*Zip:

*E-mail address:

*Home Phone:

Business Phone:

Cellular or Pager:

Facsimile:

What type of intellectual property does this matter concern?

This matter involves:

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?

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:

Where did you hear about this website?

The contents of this contact form are provided by and are the responsibility of the person posting the email communication. Your email will not create an attorney-client relationship and will not necessarily be treated as privileged or confidential. You acknowledge that any reliance on material in email communications is at your own risk.


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