I hereby submit the below suggestion for consideration.
This document (with attachments as needed) and any prototypes are a complete disclosure of my suggestion:

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I understand that Empire Level Mfg. Corp. has a policy on suggestions made by individuals not employed by Empire. Therefore, I understand that it is required that I accept the below stated conditions prior to consideration of my suggestion.

A. At my request, Empire is willing to consider my suggestion without entering into a confidential relationship. While making no agreement, Empire does not intend to disclose the suggestion less than sixty (60) days from the date of this submission.

B. No obligation of any kind is assumed by or may be implied against Empire unless or until a formal written contract has been made, and then the obligation shall be limited to the specific terms and obligations expressed in the formal written contract.

C. Empire does not, by reason of the submission of this suggestion, obtain any right under any patent I may have or later obtain on the suggestion. In consideration of the review of my suggestion by Empire, I hereby release Empire from any liability in connection therewith, except as may arise under valid existing or later-issued patents.

I accept all of these conditions and ask you to consider my suggestion and all disclosures relating to it, as well as any other suggestions that I may submit to you in the future.

I further agree that the disclosures which I submit in any form as referred to above are and will be the only disclosures which I will make; i.e., no other disclosure will be deemed to have been made unless subject to this or a subsequent similar Idea Submission Form.

All questions with an * must be completed in order to submit application.