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Home: Order Online: Provisional Patent Order Form

Provisional Patent Order Form

   
 
 1. Description

Please describe your invention:
 

 

In addition to your written description, please provide sketches or drawings of your invention. These will be filed along with your description, and can be submitted via fax or email:

Fax document to: 818-380-1908

Email documents to: provisional@patelalmeida.com

Mail documents to:

Patel & Almeida, P.C.
16830 Ventura Blvd., Suite 360
Encino, CA 91436

(NOTE: you must include the order number generated at the end of this submission in your transmittal)
 
Provisional Application Preparation (includes the $110 government fee) $610
 
3. Customer Information
 
Contact Name
 Company Name
 E-mail Address
 Telephone No.
 Address
 City
 State
 Zip Code
 Country

 Special Instructions:

 
 
4. Payment Information:
 
 Card Type: 

 
 Card Number: 
  
 Expiration Date: 
 
Verification Code: 
  (This is typically the last 3 digits on the signature panel on the back of your card)  
 Name on Card: 
  
             

 

 
 

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16830 Ventura Blvd., Suite 360, Encino, CA 91436

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