APPLICATION FOR LICENSING - US EPA



Potential Licensee Name - License # |Last Saved: September 22, 2011 | |

APPLICATION FOR LICENSING

US ENVIRONMENTAL PROTECTION AGENCY INTELLECTUAL PROPERTY

SECTION 1: IDENTIFICATION OF INVENTION(S) FOR WHICH LICENSE IS SOUGHT

Title of Patent Application(s):

Inventor(s):

Source from which you learned of availability of a license to the present invention(s):

SECTION 2: INFORMATION ABOUT APPLICANT

Name of Applicant's Primary Contact Person:

Title:

Address:

Phone: ( )

Fax: ( )

E-Mail:

Name of Applicant’s Licensing Representative:

Title:

Address:

Phone: ( )

Fax: ( )

E-Mail:

Is Applicant a U.S. Corporation? ____ Yes ____ No

If no, state country of origin:

State of incorporation or citizenship (if an individual):

Is Applicant a Small Business Firm ( ................
................

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