I. |
*Briefly
describe the subject matter of
the infringement or theft of trade
secret (for example, chemical formula
for testing chlorine level in water,
apparatus for filtering waste water,
or process for making gasoline,
etc.): |
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II. |
Do you want only general advice
regarding infringement rather
than advice regarding a specific
set of facts?
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III. |
Does this matter involve your
alleged infringement of intellectual
property rights of another (for
example, your alleged infringement
of another’s patent, copyright,
or trademark)?
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IV. |
Does this matter involve alleged
infringement of your intellectual
property rights by another (for
example, alleged infringement
of your patent, copyright, or
trademark)?
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V. |
To the best of your knowledge,
does the subject matter of the
infringement concern a patent?
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VI. |
To the best of your knowledge,
does the subject matter of the
infringement concern a trademark?
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VII. |
To the best of your knowledge,
does the subject matter of the
infringement concern a copyright?
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VIII. |
To the best of your knowledge,
does this matter involve your
alleged theft of a trade secret
belonging to another?
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IX. |
To the best of your knowledge,
does this matter involve alleged
theft of a trade secret owned
by you?
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Our
Assurance of Confidentiality
Premier IP Protection, LLC hereby
agrees that licensing information
provided herein by the individual(s)
named in this Infringement Disclosure
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, Esq.
Manager Member |
Submitter's
Statement
By submitting this Infringement
Disclosure 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 Infringement
Disclosure Form shall indicate
my agreement to this Submitter’s
Statement.
** 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. |