Name* First Last Job Title* Company/Employer* Date MM slash DD slash YYYY Email* PhoneName of Product Idea* Description of Idea*Who in the industry would benefit from this product?*Advantages of Idea*Is their a similar product on the market?* Yes No What is it similar too?(Products/Manufacturer)Have you spoken to any other Manufacturers about this idea?* Yes No What manufacturers and what was discussed?What would you pay for this product?* Other notes or comments Δ