DCP Confidentiality Agreement + Prototype Needs Questionnaire

DCP Confidentiality Agreement + Prototype Needs Questionnaire - 2019
Completing this Confidential Questionnaire entitles you to a:
- Free product review and consultation regarding your product/prototype needs
- Up to 1 hour of engineering review time without charge
- An estimate to design and build a prototype (or other service if applicable) that meets your requirements*
*Assuming product is felt to be feasible and within our capabilities

*Questionnaires that are more thoroughly completed typically have review priority.
CONTACT INFORMATION
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail*
Phone Number*

Area CodePhone Number
Best Time to Speak

Mornings (Preferred)Afternoons (Preferred)EveningsSaturdayOtherOther
About Your Product
Technical Name*
Describes Invention in Technical Terms ( i.e. - Illuminated Fishing Pole)
Marketing Name
Marketing Name if you have one (i.e - Luma Pole)
Current Problem(s) that lead to your invention?*
How does your invention solve the problem(s)?*
How exactly does it work?
List most important features and benefits*
Who would purchase this product?*
Where would this product be sold?
Please list any competitive products and why yours is better
Development Status
Legal Work Accomplished
Technical Work Accomplished
Marketing Work Accomplished
Pricing - (Real or Estimated)

Manufacturing $Retail $
How Can We Help You?
What types of pre manufacturing / manufacturing related assistance are you most interested in (please check all that apply?)
What post manufacturing marketing assistance are you interested in (Please check any/all that apply)?
What type of assistance are you most interested in right now?
Please upload (or email) all relevant product information you have (checked off above).

Upload a File
(Multiple documents/files can be selected and uploaded) Cancelof
STATEMENT OF CONFIDENTIALITY

All information disclosed to Dirt Cheap Prototypes, LLC in any manner, is protected, without exception by this statement of confidentiality and Dirt Cheap Prototypes, LLC will only use this confidential information for the purposes of providing an estimate for services, providing we feel that we can be of assistance, unless express written permission is provided to Dirt Cheap Prototypes, LLC by inventor at some future point to otherwise disclose information for the inventor's benefit.

Thomas Dowler

Project Manager,

Principal
Dirt Cheap Prototypes - 123 Washington Street - Suite 288 - Washington, PA 15301

Phone (724) 249-6183 - Fax (888) 446-0897 - Email: contact@dcpsvcs.com
Dirt Cheap Prototypes - Confidential Questionnaire
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DCP Confidentiality Agreement + Prototype Needs Questionnaire - 2019

CONTACT INFORMATION

About Your Product

Development Status

How Can We Help You?

Dirt Cheap Prototypes - Confidential Questionnaire