Start Up Seed Fund Application Form

Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
National Insurance Number
National Insurance Number or Similar
Phone Number
Email Address
emample@emample.co.uk
Business Name
Name of Your Business
Date You Started Your Business

DayMonthYear
Date
Describe Your Business
Maximum 100 Words
To be eligible you should fulfil the following criteria. Please Tick
Those who are eligible will be invited to submit a seed fund agreement to receive £500. This will be paid by BACs into a bank account suitable for business use and is to be spent on business use within the greater Ballymena area. Any questions you may have can be emailed to melanie@ballymenabusiness.co.uk or phone 07930358982
E-Signature
Submission Date

DayMonthYear
Date
Should be Empty: