Request an NDA

WORLDiscoveries™ can prepare and negotiate NDAs for you. To request an NDA, please fill in and submit the below form. A WORLDiscoveries™ representative will review the information and contact you to prepare the agreement. They will then work with the person or organization to whom you wish to disclose the information to finalize the agreement.

1. Your Party's Contact Information

Your Contact Information

First name* Last name*

Email*

Phone Number Fax

Institution

Department

Title

Office Address

Your Co-Applicant

Please provide contact information for the co-applicant of this NDA (if applicable). This person will be added to the Agreement as a designated representative.

Name

Phone Number Fax

Institution

Department

Title

Office Address

May we contact your co-applicant regarding this NDA request if we cannot reach you?
Yes No

Additional Co-applicant(s)

Please list any other co-applicant(s) for this NDA. These people will be added to the Agreement as designated representatives.

2. Other Party's Contact Information

Organization Information

Organization's Full Legal Name

Organization's Complete Address

Organization's Signing Authority (Individual who can bind the organization in a legal agreement)

Title of Signing Authority (e.g. CEO, Director)

Contact Information

Contact's Name Title

Contact's Phone Fax

Contact's Email

Other Contacts

Please list any other contacts you have at this organization, related to this NDA

3. Purpose of the NDA

Nature of the Information

What does the information relate to? (e.g. research project, technology title)

What is your purpose in providing the information?

To enable the recipient to assess the technology for potential use
To enable the recipient to evaluate a potential research collaboration
Other

If other, please provide details:

Have you previously dealt with the recipient in any way?

Yes No

If yes, please provide details:

4. Other

Have you already disclosed the technology to WORLDiscoveries™?

Yes No

If yes, please provide details (i.e. date of disclosure and contact person). If not, when do you expect to disclose.

Is there any other information we should know?

Request an NDA

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