Note:  The questions blow are designed to help you keep the details of your invention secret.  Please answer the questions as honestly as possible without disclosing any secrets.  This submission will be sent directly to Invention City.

Please provide the following contact information:

Name
Title
Organization
Work Phone
FAX
E-mail
URL

Development Status:

Manufactured Product Prototype Drawings Written Description Undeveloped

Patent Status:

US Patent Issued US Patent Pending Disclosure Document Filed Unprotected

US Patent Number (if available)

What is the anticipated retail price?

How many end users have you surveyed?

None 1-10 10+

Select all of the categories that describe your invention: 

Consumer Products
Industrial
Medical
Software
Medical
Electronics
Health and Safety
Medical
Kitchen and Bath
Sporting Goods
Games
Medical
Toys
Tools and Hardware
Food
Other

Please name some current products that compete with your invention: (Think about this question creatively. For example, blimps and airplanes compete with helicopters. The category of your invention should not be a big secret. If you have invented a new kind of screwdriver, you can say your invention competes with "screwdrivers". Your answer will help a company decide whether or not your invention is potentially a good fit for the company. A poor answer, or no answer means that your invention doesn't fit.)

Select all of the benefits that describe your invention:

Saves time
Saves money
Safer
Benefits environment
More fun
Better looking
Other

On a scale of 1 (ok) to 5 (Edison would be impressed) please rank the significance of your invention:

1 2 3 4 5