Technology Transfer Form
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The following information WILL be posted on the web site of Venture Capital Marketplace:

1. Owner/Inventor Location:

2. Invention/Technology Name:

3. Patent/Copyright/Trademark Status:

(e.g. patent number *** granted in US and Australia; pending approval by US patent office, etc.)

4. Invention/Technology development status:

(e.g., concept stage, prototyping stage, Batch production, etc.)

5. Total amount invested on the invention/technology so far : US$

6. Preferred transfer method:
(e.g. licensing, sale, partnership, etc.)

7. Contact Name:
8. Telephone Number: (country Code)-(area code)-(local phone number)
9. Fax Number: (country Code)-(area code)-(local fax number)
10. E-mail: (Enter complete address)
(Note: Email must be supplied correctly to receive a response to your submission)

11. Brief describe this Invention/Technology:

e.g. what this invention/technology can do? how it works? in what industries can it apply? what values can transferors expect from it?

The following information will NOT be published on the web site of Venture Capital Marketplace.


12. Contact Details:

Listing Submitted by:
Title:
Name of Firm:
Postal Address:
City:
State or Province:
Country:
Zip or Postal Code:
Web Site URL:

13. Permission to publish Contact Details:

I authorize VCMP to post the following contact details of my company on the Listing page   (Please uncheck those you do not wish to be published).

Contact Name    Company Address    Fax Number     Phone Number    Email     URL

14. I guarantee the information provided is true and correct to the best of my knowledge and judgment and understand that I will responsible for any false and/or incorrect information submitted.

Yes                              No

15. Service and payment selection:
 
US$ 50 Technology Transfer Listing for 3 months

 Payment Options
Send credit card details online Send cheque