Caution to inventors: Use of this form may entail disclosure of proprietary and/or confidential information. Please take appropriate steps to protect your invention before disclosure.

Survey Form

The following survey will be used in evaluating the market potential of an invention that has been disclosed to you. An honest, unbiased reply is necessary. The inventor will use your answers to help in determining whether or not he/she should proceed. Proceeding will cost the inventor a lot of time and money. Answering honestly is the best way to help the inventor make a good decision. Please answer the questions only for yourself - the inventor needs YOUR opinion about what the invention means to YOU.

For each question, please circle a number from 1 to 10. 1 is low or "not at all". 10 is high or "absolutely".

1. Do you currently own or use products that are similar, competitive, alternative, or related to the invention?
none ...1...2...3...4...5...6...7...8...9...10... many

2. Compare the invention to similar, competitive and alternative products:
it's worse ...1...2...3...4...5...6...7...8...9...10... it's better (there are none)

3. Does this invention solve a problem you've experienced?
no problem ...1...2...3...4...5...6...7...8...9...10... solves big problem

4. Compared to a product like __________, would you pay more or less for the invention?
pay much less ...1...2...3...4...5...6...7...8...9...10... pay much more

5. Would you like to buy the invention today for $_________?
never buy ...1...2...3...4...5...6...7...8...9...10... buy this instant

6. Consider the potential safety hazards to yourself and others when using this invention. How do you consider it?
dangerous ...1...2...3...4...5...6...7...8...9...10... completely safe

7. Comments and suggestions: