Submission Form
If your product satisfies our criteria listed above please complete the Submission Form below.

*Required

* I have read and agree with the Terms and Conditions listed in the Dreamstart Submission Agreement Form and the Dreamstart Non-Confidential Agreement Form

Name *
Company
Address *
City *
State *
Zip *
Day Phone No.*
Night Phone No.
E-mail address*

Product Category (Check as many as apply)
Automotive Aftermarket
Household Cleaning
Household Appliances
Lawn & Garden
Food and Beverage
Personal Care (Health & Beauty)
Electronics
Office Supply
Toys and Games
Other

Product description (provide short detail)

What is the stage of your product?
Conceptual?
Design phase completed?
Prototype completed?

Infomercial
Infomercial or short form produced?
(If checked, date produced)
(i.e., 11/11/02)
Length of commercial

Tested? (If checked, date tested)
(i.e., 11/11/02)
Please describe test results

Is the infomercial currently running?

How much is being spent each week on media time?

Production
In production? (If checked, monthly capacity)

Distribution
In distribution? (If checked, US or International?)

Advertising completed? (If checked, type of advertising)

Sold in retail stores?

Funding Request
How much money are you seeking?

How will the money be utilized?
(Total should equal 100%)
Inventory %
Advertising Production %
Molds/Tooling %
Receivables funding %
Plant and Equipment %
Product Design %
Other %

Do you own the rights to the product?

Intellectual Property
US Patents
International Patent Status
Trademarks
Countries Patents Registered