Tool Name or Description *

Submitter Name

Have You Made Samples of the Tool? *

Have You Used the Tool for its Designed Purpose? *

Have You Sold Any Such Tools? *

If Yes, When?

If Yes, Please Give Date and Details

Do You Have a Patent or Patent Pending? *

Patent Number

Additional Information or Sketches (Optional)

Idea Submission Statement

My idea relating to the subject identified below is submitted to Milton Industries on a non-confidential basis, and its submission does not obligate Milton Industries in any way. I understand that upon submission of my idea, Milton Industries will promptly review and consider whether Milton desires to offer me an award or royalty contract to use the idea. In the event I do not enter into a contract with Milton Industries, I understand that Milton assumes no obligation, and that any claim which I may have shall be based solely upon patent rights I might now have or will obtain on my idea.

Idea Relating To *

Submitter Information

Name *

Work Phone *

Address *

City, State ZIP *

Home Phone *

Email Address *

Sketch or Detailed Description of Idea *

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We appreciate you contacting us. One of our colleagues will get back in touch with you soon!

Have a great day!

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ZE373 - Polypropylene Lever Pump (1 Pint Per Stroke)