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First Name: Surname: Address: Suburb: State: VIC NSW ACT QLD SA NT TAS WA Postcode:	Company Name: Email: Phone: Mobile: Fax:

Product Information

Product Name:  Brief Description:

Intellectual Property

Have you applied for IP protection?  Yes    No If yes, what type?  Have you conducted a patent search?  Yes    No If yes what was the result?

Market Research

Who will buy your product or utilise your service? Who are your competitors?  Have you undertaken any market research?  Yes    No If Yes, please detail.

Commercialisation Options

Which one of the following would you like to do?  Establish a Business License or Sell to a Third Party Arrange a Joint Venture Unsure – need advice Which stage of development are you at? Early Stage (e.g. Just an idea) Prototyping/Testing Development Stage (e.g. manufacturing) Later Stage (Working on Business Plan) Ready to Commercialise On the market What kind of assistance do you require? (hold down 'Ctrl' to select multiple) Grants & Finance IP/Patent Searching Research Commercialisation/Strategic Planning Identifying Licensees or Manufacturers Sales & Marketing Unsure – Need guidance    Other (Please specify)

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