Technical Evaluation Form Please enter your response for each question, then click the Submit button at the bottom of the page. 1. Please generally describe your device.
2. Does the device require input of energy to begin functioning? If so, how much and for how long?
3. If any input is required, what is the source of the energy?
4. What amount of energy output does your device create (in full watts, not milliwatts)?
5. How did you measure the input and output?
6. What is the ratio of input to output (that is, how many times over unity is it?)?
7. Do you have other partners or investors who must give permission for you to have the device tested and licensed? Did you develop this technology with someone else? Who?
8. Do you have an inventors notebook or other evidence of the date of conception and a record of the development of the device?
9. Have you applied for or been granted a patent? When? What patent number? Who was the patent attorney?
10. Has the technology been demonstrated, shown or described in detail to others? To whom and under what conditions was it demonstrated? Was a non-disclosure agreement (NDA) in place BEFORE the demonstration or description?
11. Are you willing to have the prototype tested transparently (that is, no black boxes) at other facilities? Under what conditions and requirements?
12. What do you need and want personally in order to license the technology for commercialization? 3
13. What is the physical appearance (size, any exotic materials)? (Note: we are NOT asking for description of workings yet. We want to know if it is practical for home or business sales and use.)
14. Are you open to our visiting you and doing an onsite preliminary test by our team? When? Where?
15. Do you have any questions for us?
16. Enter your contact information - REQUIRED
Fax (if any):
17. Who else do you know that we should talk to (and why)?