Technology Request Form - FLC Souteast Region

**All technical information on this form will be shared only with technology source organizations, namely US Federal laboratories and/or universities, as a means to assist in identifying technologies applicable to your needs. For added security, please omit proprietary information, trade secrets and other company-sensitive information.

Technology Request Form PDF

Technology Request Form
We will submit your request to our laboratories and provide you with contact information for persons at the laboratories who can assist you in the technology transfer process.
You can also review available laboratory technologies.


Your name and contact information is required and will be held in confidence.
Date:
Name:
Organization:
Address:
City, State, Zip:
Contact Phone:	Ext.
Fax:
Email:
Your company is (check one):	US-owned and Operated Foreign-owned and Operated
1. Please describe in detail the technical problem you wish to address and the type(s) of technology you are seeking:
2. To prevent duplication of efforts, please describe what steps you have already taken to develop or locate the needed technology. Please name organizations you have already contacted, similar technologies you have reviewed, and any other pertinent information.:
3. Please provide any additional relevant information that will assist us in identifying technologies with the potential of meeting your needs: