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Michael Kroll, Registered Patent Attorney - Confidential Disclosure Form

Three Ways To Submit Your Invention To Our Office

  1. Fill out the confidential form below and press submit - you will receive an immediate response, OR

  2. Print a blank Confidential Disclosure Form, fill in the necessary information and mail or fax to:

    Michael I. Kroll
    115 Eileen Way, Suite 105
    Syosset, NY 11791

    Fax: 1-800-367-7999

    you will receive a response by mail within a few days, OR

  3. Request our Free Brochure which includes a Confidential Disclosure Form, fill it out and mail it back to us in the envelope provided for your use.

Confidential Disclosure Online Form

*all information strictly confidential - filling out this form does not obligate you financially in any way
Upon completion of this form you will receive:
  • a free no obligation evaluation of your invention by Mr. Kroll sent to you by e-mail
  • a free no obligation fee estimate as to the total cost to write and file a patent application

Please fill out the form below and click submit when completed:

    required *
Today's Date: *
First Name: *
Last Name: *
Street Address Line 1: *
Street Address Line 2:
City: *
State: *
Zip Code: *
Country:
Email Address: *
Home Phone w/area code:
Work Phone w/area code:
Fax # w/area code:
Name Of Invention:
Do you have a model or prototype?:
Brief Description Of Invention: *
Advantages Of Your Invention:




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