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Business Development-Client Intake Form
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Email
*
Your email
Today's date
MM
/
DD
/
YYYY
Company's Name
Your answer
Phone Number
Your answer
Product Name
Your answer
Briefly describe technology - new product, invention, process ( attach product literature, drawing, or photos as needed
Your answer
Briefly describe the problem that the technology solves and its advantages/benefits relative to competing technologies or products. What are the novel aspects of the invention? Are there new marketing drivers that are encouraging you to develop this product? If so please identify
Your answer
Stage Development
Concept
Concept of Proof
Working Model
Demo
Prototype
Fully Developed
Clear selection
Are samples and/or prototypes available to share with potential industry partners?
Yes
No
Clear selection
Do you have a completed business plan which focuses on this new product/process opportunity:
Yes
No
Clear selection
Please list the major market/s that you are hoping to target with this innovation product/process? (e.g Robotics, Pharmaceutical-drug discovery)
Your answer
Please list major companies and their respective product or process that are currently providing a competitive offering
Your answer
What are some of the product's strength compared to the competition?
Your answer
What are some of the product's weakness compared to the competition?
Your answer
Please check the box that best describes where this product/process is in the patent process.
provisional patent application filed
conventional patent application filed
patent application approved
not applicable/haven’t started patent process.
Have you publicly disclosed this invention in one the following; seminar, presentation, poster session, publication, thesis defense, or cooperate presentation?
Your answer
What is the status of the intellectual property as it relates to this invention/ discovery?
will be individually owned
owned by and placed into a newly formed company
owned by a college/university- licensed to a company
unknown- not certain at this point
other
What are the initial project costs estimated to commercialize this product/invention?
$0 - 500,000
$500,001 - $1,000,000
> $1,000,000
unknown or undefined at this time
Clear selection
If the answer to question 11 was any response other than "unknown or undefined" - what sources or start up financing have you or would you like to consider?
None, project will be privately funded
SBIR/STTR
Angel investment
Venture Capital
Private Investment
Joint Venture/Industry Partnership
other
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