Premier IP Protection, LLC
"Our Law Firm Protects Your Creativity"
Premier IP Protection, LLC
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General Disclosure Form

This document should be used if you are not sure which of the enumerated disclosure forms to use. You may fill-out this form and then return it to us via email by pressing the “submit” button at the end of this form. Alternatively, you may print-out this form, fill-in the requested information and return it to us by U.S. post office mail or facsimile

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*Your Name:
(first, middle, last)
Home Address:
Mailing Address:
City:
City:
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State:
Zip:
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*Home Phone:
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I.
Even if you are not sure which of the enumerated disclosure forms to use, can you make a best guess from the following list (check all that might apply)?
Patent
Copyright
Trademark
Trade Secret
Licensing
Infringement
Still Not Sure
II.
*Describe in your own words, the nature of your inquiry:

Our Assurance of Confidentiality
Premier IP Protection, LLC hereby agrees that the information provided herein by the individual(s) named in this form will not be revealed, used, disclosed, sold, or transferred without his or her express authorization, except if required by court order.

For Premier IP Protection, LLC:
Walter S. Stevens
Walter S. Stevens, Esq.
Manager Member

Submitter's Statement
By submitting this form and any other information pertaining thereto, I acknowledge that Premier IP Protection, LLC is accepting this information for review purposes only.  I understand that any comments that I receive based upon this review are based upon a limited analysis and is neither meant nor understood to be a conclusive legal opinion.  Further, I agree that Premier IP Protection, LLC cannot be held responsible for any recommendations based upon the review of the information herein and cannot be held responsible for the return of any submitted materials.  Even if no signature(s) for the individual(s) named hereinabove is/are included in the submitted form, I/we acknowledge that the submission of this form shall indicate my agreement to this Submitter’s Statement.

Signature**:
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** There is no need sign this form, if returning this form online. It will be assumed that the completed form is from the individual whose name appears above.

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