The Company America Trusts for Inventions

Confidential Invention Disclosure
In consideration of the disclosure of Confidential Information as defined herein by the undersigned inventor(s) to Jacob Enterprises, Inc., Jacob Enterprises, Inc. hereby agrees to hold and maintain the Confidential Information in strictest confidence, to not disclose the Confidential Information to any third party and to use the Confidential Information only for purposes of analyzing and evaluating opportunities to sell or distribute products based on the Confidential Information. “Confidential Information” shall include all technical or business information relating to the products and/or inventions identified within and provided to Jacob Enterprises, Inc. “Confidential Information” shall not include any information that is: (a) publicly known at the time of disclosure or subsequently becomes publicly known through no fault of Jacob Enterprises, Inc.; (b) already known to Jacob Enterprises, Inc. at the time it was disclosed or independently developed by Jacob Enterprises, Inc. without the benefit of the Confidential Information; or (c) learned by Jacob Enterprises, Inc. through legitimate means from a third party who has the right to disclose it without restriction. The confidential disclosure statement above is designed to protect your idea and to provide Invention Home’s guarantee of confidentiality. We value the confidentiality of your invention. Jacob Enterprises’ core business is to provide assistance to inventors in securing 3rd party licensing agreements for new product ideas / inventions. We also offer secondary services to assist with patent searching conducted through an independent patent attorney / agent firm and provide advisory services to assist in filing a Provisional Patent Application, which includes grammar, spelling, and overall presentation. We are not a law firm and cannot offer legal services or opinions relating to the sufficiency or technical aspects of a provisional patent application for any purpose including patentability or market potential. We do offer patent attorney / agent referrals when appropriate. Company Signatures:

Russell Williams President & CEO

Eric Zalevsky Vice President, Product Development

To Get Started with Your Idea/Invention:
• Complete the non-disclosure form in its entirety • Mail or fax the completed form back to Jacob Enterprises, Inc. (Attention: New Ideas & Inventions) • Contact us at 1-866-THINK-12 to discuss your first step Mail To: Jacob Enterprises, Inc. 275 Center Road, Suite 105 Monroeville, PA 15146-1451 Fax To: 412-229-1350

The Company America Trusts for Inventions

Inventor[s] Information:
Inventor Name: ______________________________

Day Phone: (_____)______________________

Street Address: ______________________________ Evening Phone: (_____)__________________ City/State/Zip: _______________________________ Email Address: ______________________________ Best Time to Call: _______________________

Title of Invention:

Additional Inventors:

Please list any other inventors who contributed to the formation or conception of the idea/invention.

Idea/Invention Description (provide detailed explanations):
Describe the purpose of the idea/invention by explaining who would use it and how. (Attach additional detail, if needed):

Describe the problem that the idea/invention solves for the user and explain why it is necessary. (Attach additional detail, if needed):

The Company America Trusts for Inventions

Please provide details of the idea/invention:


1. Explain in detail what the idea/invention looks like:

2. What are the approximate dimensions (if applicable)? Height __________ Length __________ Width __________ Diameter __________

3. Explain in detail how the idea/invention works:

4. What makes your idea/invention unique or better than other products?

Yes Do you have a prototype of your idea/invention?


Do you have drawings or artwork?

Do you have any other information showing your idea/invention?

The Company America Trusts for Inventions
PAGE 4 If possible, please provide a sketch of your idea/invention (the sketch does not have to be perfect).


I understand that Jacob Enterprises, Inc. (JEI) will not evaluate my invention for market potential or patentability and cannot guarantee or offer opinions on my product’s market success potential. Further, I understand that the patent process may be used to protect my rights as an inventor and that JEI has not provided me with legal advice. I am confidentially disclosing my invention to JEI only for their assistance in marketing my invention to potential licensees and that further action may be required in the United States Patent & Trademark Office by me to secure utility and/or design patent protection.

Inventor[s] Signature: __________________________________________________________________ Date: ______________