Prospective Client Request For Patent Services

(specify primary services/products/goods provided)
Current monthly expenses:
Current Year-to-Date Gross Income from Other Source:
  • * Most recently filed Form 1040, including all Schedules, W-2 and/or 1099 Forms (please redact social security number)
  • * Two most recent paystubs
  • * Year-to-date and prior year business financials (profit & loss, balance sheet)
  • * Statement/Declaration of Income and Expense

Please note submitting this form does not make us your attorneys. We are an educational clinic; we do not operate as a traditional law firm. Accordingly, if your matter is time sensitive or you require a more immediate response, please contact another patent attorney. The Patent Clinic reserves the right to waive all or any portions of the client eligibility criteria.

Please email:
or FAX 919-530-7892
or Mail to:
640 Nelson Street,
Durham, NC 27707